Basic Information
| Provider Information | |||||||||
| NPI: | 1396785242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 142 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245412922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4347993742 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 71ST STREET | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331413089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058669951 | ||||||||
| FaxNumber: | 8772848933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/07/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101043552 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 0101043552 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005883725 | 05 | VA | MEDICAID | 005886121 | 05 | VA | MEDICAID | 005878055 | 05 | VA | MEDICAID | BS3519723 | 01 | DEA REG | OTHER | 005878021 | 05 | VA | MEDICAID | 005878063 | 05 | VA | MEDICAID |