Provider Demographics
NPI:1558432013
Name:STEIN, BRENDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:A
Last Name:STEIN
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 1:1803 N WATERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2938
Mailing Address - Country:US
Mailing Address - Phone:765-714-7592
Mailing Address - Fax:
Practice Address - Street 1:1803 N WATERVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2938
Practice Address - Country:US
Practice Address - Phone:765-714-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010-54130A207Q00000X
TXJ0281207Q00000X
WAMD00049429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF43963Medicare UPIN