Provider Demographics
NPI:1508805219
Name:STEPHENS, BRETT W (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:W
Last Name:STEPHENS
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 1:8411 FM 1960 BYPASS RD W
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4013
Mailing Address - Country:US
Mailing Address - Phone:346-616-5862
Mailing Address - Fax:
Practice Address - Street 1:8411 FM 1960 BYPASS RD W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4013
Practice Address - Country:US
Practice Address - Phone:346-616-5862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3751207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J0779OtherBCBSTX
TX182211601Medicaid
TX8J0779OtherBCBSTX
I56665Medicare UPIN