Provider Demographics
NPI: | 1598720583 |
---|---|
Name: | HOUGEN, STEPHEN THORSHEIM (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | STEPHEN |
Middle Name: | THORSHEIM |
Last Name: | HOUGEN |
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: | PO BOX 674339 |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75267-4339 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 830-201-7100 |
Mailing Address - Fax: | 830-201-7304 |
Practice Address - Street 1: | 800 W HIGHWAY 71 |
Practice Address - Street 2: | |
Practice Address - City: | MARBLE FALLS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78654-8602 |
Practice Address - Country: | US |
Practice Address - Phone: | 830-201-7100 |
Practice Address - Fax: | 830-201-7304 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-04-20 |
Last Update Date: | 2013-07-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | F1660 | 208600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 131304103 | Medicaid | |
TX | 88620S | Other | BLUE CROSS/SHIELD |
TX | 8BV700 | Other | BLUECROSS BLUESHIELD OF TEXAS |
TX | 8BV700 | Other | BLUECROSS BLUESHIELD OF TEXAS |
TX | 88460K | Medicare ID - Type Unspecified |