Provider Demographics
NPI:1023540002
Name:STALLARD, STEVEN ANDREW
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANDREW
Last Name:STALLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:STALLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:SAMMC, MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:SAMMC, MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-5910
Practice Address - Fax:210-916-2077
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8995208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice