Provider Demographics
NPI:1275758047
Name:SMITH, STEPHEN LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:798 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-7283
Mailing Address - Country:US
Mailing Address - Phone:830-990-8200
Mailing Address - Fax:830-990-8200
Practice Address - Street 1:798 BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-7283
Practice Address - Country:US
Practice Address - Phone:830-990-8200
Practice Address - Fax:830-990-8200
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8426202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner