Provider Demographics
NPI:1568469203
Name:GREENFIELD, STEPHEN (PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:430 W SUNSET RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1772
Mailing Address - Country:US
Mailing Address - Phone:210-824-4584
Mailing Address - Fax:210-805-8466
Practice Address - Street 1:430 W SUNSET RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1772
Practice Address - Country:US
Practice Address - Phone:210-824-4584
Practice Address - Fax:210-805-8466
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00689363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3142911-01OtherWELLMED MEDICAID
TXB152755OtherWELLMED MEDICAL GROUP PA