Provider Demographics
NPI:1477090124
Name:GUIMONT, STEPHAN (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:GUIMONT
Suffix:
Gender:F
Credentials:LMT
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 171544
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75017-1544
Mailing Address - Country:US
Mailing Address - Phone:214-457-2507
Mailing Address - Fax:
Practice Address - Street 1:4186 W PIONEER DR
Practice Address - Street 2:APT 3086
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-8566
Practice Address - Country:US
Practice Address - Phone:214-457-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT106761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist