Provider Demographics
NPI:1174628564
Name:TANKERSLEY, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:TANKERSLEY
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 1:3500 OAK LAWN
Mailing Address - Street 2:SUITE 370
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4308
Mailing Address - Country:US
Mailing Address - Phone:214-528-9240
Mailing Address - Fax:214-559-0803
Practice Address - Street 1:3500 OAK LAWN
Practice Address - Street 2:SUITE 370
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4308
Practice Address - Country:US
Practice Address - Phone:214-528-9240
Practice Address - Fax:214-559-0803
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG01882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00GH13OtherMEDICARE SUBMITTER ID