Provider Demographics
NPI:1114944766
Name:STEPHENS, STACY RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:RANDOLPH
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 GLADESIDE CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2111
Mailing Address - Country:US
Mailing Address - Phone:972-931-6124
Mailing Address - Fax:972-931-6164
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:MOB 1 SUITE 502
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7939
Practice Address - Country:US
Practice Address - Phone:972-312-1309
Practice Address - Fax:972-312-1662
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5324207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX824472OtherBLUE CROSS BLUE SHIELD
TX824472Medicare PIN
TX824472OtherBLUE CROSS BLUE SHIELD