Provider Demographics
NPI:1659372290
Name:STEPHENS, CHAD B (DO)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:B
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 E STATE HIGHWAY 114 STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4416
Mailing Address - Country:US
Mailing Address - Phone:817-518-1112
Mailing Address - Fax:817-518-1113
Practice Address - Street 1:431 E STATE HIGHWAY 114 STE 120
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4416
Practice Address - Country:US
Practice Address - Phone:817-518-1112
Practice Address - Fax:817-518-1113
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3143207QS0010X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148234112Medicaid
TX8CG731OtherBCBS
TX8F24397Medicare PIN