Provider Demographics
NPI:1548657067
Name:STEVENS, PAUL R (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3 NEENAH CTR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:920-738-4800
Mailing Address - Fax:920-738-5749
Practice Address - Street 1:4480 W SPENCER ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-9106
Practice Address - Country:US
Practice Address - Phone:920-738-4800
Practice Address - Fax:920-738-5749
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2021-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI66341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine