Basic Information
Provider Information | |||||||||
NPI: | 1962471490 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STEPHENS | ||||||||
FirstName: | RONALD | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 330 ARKANSAS ST | ||||||||
Address2: | SUITE 105 | ||||||||
City: | LAWRENCE | ||||||||
State: | KS | ||||||||
PostalCode: | 660441335 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7858402800 | ||||||||
FaxNumber: | 7858402813 | ||||||||
Practice Location | |||||||||
Address1: | 330 ARKANSAS ST | ||||||||
Address2: | SUITE 105 | ||||||||
City: | LAWRENCE | ||||||||
State: | KS | ||||||||
PostalCode: | 660441335 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7858402800 | ||||||||
FaxNumber: | 7858402813 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/16/2006 | ||||||||
LastUpdateDate: | 05/20/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 04-13575 | KS | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
ID | Type | State | Issuer | Description | 2050932602 | 05 | KS |   | MEDICAID | 36-00127 | 01 |   | UNITED HEALTHCARE | OTHER | 423050 | 01 |   | FIRST GUARD | OTHER | 24510021 | 01 |   | BC/BS KANSAS CITY | OTHER | 830007296 | 01 |   | MEDICARE RAILROAD | OTHER | 100532 | 01 |   | BC/BS OF KANSAS | OTHER | 2422210 | 01 |   | AETNA | OTHER |