Provider Demographics
NPI:1407855547
Name:MCKERNAN, STEPHEN L (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:MCKERNAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:690 S LOOP 336 W STE 200
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3320
Mailing Address - Country:US
Mailing Address - Phone:936-525-3600
Mailing Address - Fax:936-525-3624
Practice Address - Street 1:690 S LOOP 336 W STE 200
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3320
Practice Address - Country:US
Practice Address - Phone:936-525-3600
Practice Address - Fax:936-525-3624
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL5835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158125802Medicaid
TX1581258-02Medicaid
TXF18042Medicare UPIN
TX1581258-02Medicaid