Provider Demographics
NPI:1548296395
Name:STREET, STEVEN (DO)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:STREET
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:1601 E BROADWAY
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-815-2700
Practice Address - Fax:573-815-3693
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102907207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243399979Medicaid
MO274142OtherGROUP HEALTH
MOP00321686Medicare PIN
MO952174891Medicare PIN
MO274142OtherGROUP HEALTH