Provider Demographics
NPI:1659323988
Name:STEPHENS, STEPHANIE R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:STEPHENS
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 1:6750 N MACARTHUR BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2469
Mailing Address - Country:US
Mailing Address - Phone:214-556-0555
Mailing Address - Fax:972-985-4797
Practice Address - Street 1:6750 N MACARTHUR BLVD STE 270
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2469
Practice Address - Country:US
Practice Address - Phone:214-496-9700
Practice Address - Fax:214-496-9707
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8203207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1646655-03Medicaid
TX164665502Medicaid
TX164665501Medicaid
TX164665501Medicaid
TXG51251Medicare UPIN
TX8B7481Medicare ID - Type Unspecified
TXTXB157562Medicare PIN
TX8B5959Medicare ID - Type Unspecified