Provider Demographics
NPI:1518979657
Name:SPRINGER, STEPHEN BRADLEY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BRADLEY
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 S STAPLES ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-0002
Mailing Address - Country:US
Mailing Address - Phone:361-882-5560
Mailing Address - Fax:361-882-6011
Practice Address - Street 1:601 TEXAN TRAIL
Practice Address - Street 2:STE 300
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2549
Practice Address - Country:US
Practice Address - Phone:361-854-0811
Practice Address - Fax:361-806-5040
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02316363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
87N509Medicare PIN
TX345609YZ4TMedicare PIN
TX345609YZ4TMedicare PIN