Provider Demographics
NPI:1164493060
Name:STEFKO, RAYMOND MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MATTHEW
Last Name:STEFKO
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 1:4499 MEDICAL DR
Mailing Address - Street 2:METHODIST PLAZA SUITE 235
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-692-1613
Mailing Address - Fax:
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:METHODIST PLAZA SUITE 235
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-692-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6410207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196305001Medicaid
TX196305001Medicaid
TX8K0601Medicare PIN