Provider Demographics
NPI:1437241296
Name:STERN, JUAN R (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:R
Last Name:STERN
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 1:1213 HERMANN DR
Mailing Address - Street 2:SUITE 720
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:716-526-1088
Mailing Address - Fax:713-526-3863
Practice Address - Street 1:1213 HERMANN DR STE 720
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7013
Practice Address - Country:US
Practice Address - Phone:716-526-1088
Practice Address - Fax:713-526-3863
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5446208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116321407Medicaid
TXP01338473OtherRAILROAD MEDICARE
TXC22257Medicare UPIN
TX116321407Medicaid
TXC22257Medicare UPIN