Provider Demographics
NPI:1174986293
Name:AVERA, STEPHEN A (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:AVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF TENNESSEE 920 MADISON AVENUE SUITE 534
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-0001
Mailing Address - Country:US
Mailing Address - Phone:901-448-5737
Mailing Address - Fax:901-448-7836
Practice Address - Street 1:UNIVERSITY OF TENNESSEE 920 MADISON AVENUE SUITE 447
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2933
Practice Address - Country:US
Practice Address - Phone:901-448-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000059602207R00000X, 390200000X
ORMD214746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine