Provider Demographics
NPI:1528204997
Name:MENES, STEPHANIE IFEOMA (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:IFEOMA
Last Name:MENES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6619 FOREST HILL DR.
Mailing Address - Street 2:SUITE 30
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1260
Mailing Address - Country:US
Mailing Address - Phone:817-563-6985
Mailing Address - Fax:817-563-4064
Practice Address - Street 1:6619 FOREST HILL DR.
Practice Address - Street 2:SUITE 30
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76140-1260
Practice Address - Country:US
Practice Address - Phone:817-563-6985
Practice Address - Fax:817-563-4064
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine