Doctor Name: | MR. RICHARD ALAN STEVENSON |
NPI Number: | 1215319926 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CSFA |
License Number: | |
Business Practice Address: | 187 Vine St Fairborn, OH - 453243324 |
Business Phone Number: | 9375721877 |
Business Fax Number: | |
Mailing Address: | 187 Vine St, FAIRBORN |
State: | OH |
Postal Code: | 453243324 |
Phone Number: | 9375721877 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2015 |
NPI Last Update Date: | 06/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |