Provider Demographics
NPI:1548262322
Name:STEVENS, DAMIEN R (MD)
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:R
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MAIL STOP 3007
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2937
Mailing Address - Country:US
Mailing Address - Phone:913-588-6045
Mailing Address - Fax:913-588-4098
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MAIL STOP 3007
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2937
Practice Address - Country:US
Practice Address - Phone:913-588-6045
Practice Address - Fax:913-588-4098
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003023604207RC0200X, 207RP1001X
KS0430396207RC0200X, 207RP1001X
KS04-30396207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS104188OtherBCBS KS
10001668700OtherCOMMUNITY HEALTH PLAN
MO208198416Medicaid
MO21782034OtherBCBS KC
KS200004070AMedicaid
MO0217645Medicare ID - Type Unspecified
G01097Medicare UPIN
MO0217645AMedicare ID - Type Unspecified
KS200004070AMedicaid
MO0217645CMedicare ID - Type Unspecified
MO21782034OtherBCBS KC