Provider Demographics
NPI:1447494570
Name:STEVENS, MATTHEW SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
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 1:618 PEGRAM DR
Mailing Address - Street 2:P O BOX 2180
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6322
Mailing Address - Country:US
Mailing Address - Phone:662-844-6513
Mailing Address - Fax:662-844-1113
Practice Address - Street 1:618 PEGRAM DR.
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6632
Practice Address - Country:US
Practice Address - Phone:662-844-6513
Practice Address - Fax:662-844-1113
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23029207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03177353Medicaid
MS03177353Medicaid