Provider Demographics
NPI:1073521886
Name:STEPHENSON, JILL STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:STANLEY
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:WADLEY TOWER, SUITE 958
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-826-6276
Mailing Address - Fax:214-826-6223
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:SUITE 958
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-826-6276
Practice Address - Fax:214-826-6223
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3752208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F8666OtherBCBS
TXI69053Medicare UPIN
TX8F8666OtherBCBS
TX8J2347Medicare PIN
TXP00898345Medicare PIN