Provider Demographics
NPI:1669459095
Name:STEPHENSON, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:STEPHENSON
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 650409
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-0409
Mailing Address - Country:US
Mailing Address - Phone:972-475-7500
Mailing Address - Fax:214-427-8650
Practice Address - Street 1:7801 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4247
Practice Address - Country:US
Practice Address - Phone:972-475-7500
Practice Address - Fax:214-427-8650
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6629208600000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208600000XAllopathic & Osteopathic PhysiciansSurgery