Provider Demographics
NPI:1033107131
Name:BRICK, STEPHEN EDWARD SR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:BRICK
Suffix:SR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:659 STEVES AVE
Mailing Address - Street 2:L&H PACKING CONCENTRA CLINIC
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210
Mailing Address - Country:US
Mailing Address - Phone:210-532-3241
Mailing Address - Fax:210-531-1296
Practice Address - Street 1:659 STEVES AVE
Practice Address - Street 2:CONCENTRA AT L&H PACKING
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210
Practice Address - Country:US
Practice Address - Phone:210-532-3241
Practice Address - Fax:210-531-1296
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-09-03
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Provider Licenses
StateLicense IDTaxonomies
TXPA00510363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB119451Medicare PIN