Provider Demographics
NPI:1346298890
Name:OLMSTEAD, STEPHEN MARK (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:760 N SHILOH RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5714
Practice Address - Country:US
Practice Address - Phone:972-272-4463
Practice Address - Fax:972-272-7137
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8336207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155797704Medicaid
TX8A6160OtherBCBS PROVIDER ID
TX155797703Medicaid
TX155797704Medicaid
TX8A6160OtherBCBS PROVIDER ID
TXE92000Medicare UPIN