Provider Demographics
NPI:1235263633
Name:JANECEK, STEPHEN CRAIG (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CRAIG
Last Name:JANECEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7523 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4809
Mailing Address - Country:US
Mailing Address - Phone:281-489-8780
Mailing Address - Fax:281-489-9577
Practice Address - Street 1:7523 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-4809
Practice Address - Country:US
Practice Address - Phone:281-489-8780
Practice Address - Fax:281-489-9577
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J86DMedicare PIN
TXEO4512Medicare UPIN