Provider Demographics
NPI:1417243338
Name:STEVENS, SAMUEL HOUSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:HOUSTON
Last Name:STEVENS
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:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78292-0343
Mailing Address - Country:US
Mailing Address - Phone:830-627-3800
Mailing Address - Fax:830-625-2235
Practice Address - Street 1:250 E BASSE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-8408
Practice Address - Country:US
Practice Address - Phone:210-614-9955
Practice Address - Fax:210-614-9966
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ3974207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409248YYRMMedicare PIN
TX409248YK00Medicare PIN