Provider Demographics
NPI:1609854934
Name:ROBERTS, STEPHEN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PATRICK
Last Name:ROBERTS
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 1:225 E SONTERRA BLVD
Mailing Address - Street 2:201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3992
Mailing Address - Country:US
Mailing Address - Phone:210-499-0060
Mailing Address - Fax:
Practice Address - Street 1:225 E SONTERRA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3992
Practice Address - Country:US
Practice Address - Phone:210-499-0060
Practice Address - Fax:210-499-0060
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5537171000000X, 208G00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)