Provider Demographics
NPI:1861597684
Name:STEPHENS, JOHN V (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:STEPHENS
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 1:1250 BURNS WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-2155
Mailing Address - Fax:406-752-0252
Practice Address - Street 1:1250 BURNS WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-2155
Practice Address - Fax:406-752-0252
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3823225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT62127Medicaid
MT62127Medicaid
MT9129Medicare ID - Type Unspecified