Provider Demographics
NPI:1558706739
Name:STEPHENS, CHARLES CLINTON (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CLINTON
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 1:11503 NW MILITARY HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1895
Mailing Address - Country:US
Mailing Address - Phone:210-233-6363
Mailing Address - Fax:
Practice Address - Street 1:11503 NW MILITARY HWY STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1895
Practice Address - Country:US
Practice Address - Phone:210-233-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8797207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine