Provider Demographics
NPI:1609300920
Name:STEVENS, PATRICK LEE (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LEE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 WINSTON RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642-2217
Mailing Address - Country:US
Mailing Address - Phone:336-526-2377
Mailing Address - Fax:
Practice Address - Street 1:546 WINSTON RD
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642-2217
Practice Address - Country:US
Practice Address - Phone:336-526-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005750A207Q00000X
NC2022-00899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300037866Medicaid