Stevens, Jonathan Craig

Stevens, Jonathan Craig is an sole proprietor health care provider with primary practice located at 105 Vermeer Dr Unit 1 , Ponderay ID 83852-9802. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM. Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM is his primary health care specialty. Stevens, Jonathan Craig can be contacted via phone (208) 266-1677.

Contact Information

Primary practice address
105 Vermeer Dr Unit 1 Ponderay ID 83852-9802
Phone: (208) 266-1677
Fax: (208) 266-0440
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X M7507 Idaho
Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM 204D00000X M7507 Idaho

Profile Details

NPI number 1366495178
LBN Legal business name Stevens, Jonathan Craig
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 19th, 2006
Last updated Jul 21st, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366495178 NPPES
Idaho MEDICAID 805192200

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