Provider Demographics
NPI:1659329027
Name:ADAMS, STEPHEN MOORE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MOORE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-1013
Mailing Address - Country:US
Mailing Address - Phone:210-233-7000
Mailing Address - Fax:210-277-5199
Practice Address - Street 1:3066 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-1013
Practice Address - Country:US
Practice Address - Phone:210-233-7000
Practice Address - Fax:210-277-5199
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2406363LP0200X
TX559709363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX559709OtherLICENSE
TX559709OtherLICENSE