Provider Demographics
NPI:1245432582
Name:FORDAN, STEVE VINCENT ESTOY (MD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:VINCENT ESTOY
Last Name:FORDAN
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 1:1018 N ZANG BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4123
Mailing Address - Country:US
Mailing Address - Phone:214-412-2160
Mailing Address - Fax:972-427-5151
Practice Address - Street 1:1018 N ZANG BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4123
Practice Address - Country:US
Practice Address - Phone:972-266-8765
Practice Address - Fax:972-266-5511
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3223207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CA477OtherBLUE CROSS/BLUE SHIELD
TX8CA477OtherBLUE CROSS/BLUE SHIELD