Provider Demographics
NPI:1376582718
Name:FEHRENKAMP, STEVEN HARRY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:HARRY
Last Name:FEHRENKAMP
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 1:1221 W BEN WHITE BLVD STE 208A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7181
Mailing Address - Country:US
Mailing Address - Phone:512-445-2833
Mailing Address - Fax:512-445-4121
Practice Address - Street 1:1221 W BEN WHITE BLVD STE 208A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7181
Practice Address - Country:US
Practice Address - Phone:512-445-2833
Practice Address - Fax:512-445-4121
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8463207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0063MHOtherBLUE CROSS BLUE SHIELD
TX083858301Medicaid
TX0063MHOtherBLUE CROSS BLUE SHIELD
TX083858301Medicaid