Provider Demographics
NPI:1699038562
Name:STEPHANIE STEPHENS MD PA
Entity Type:Organization
Organization Name:STEPHANIE STEPHENS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-824-7744
Mailing Address - Street 1:1015 N CARROLL AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6613
Mailing Address - Country:US
Mailing Address - Phone:214-824-7744
Mailing Address - Fax:214-824-7755
Practice Address - Street 1:1015 N CARROLL AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6613
Practice Address - Country:US
Practice Address - Phone:214-824-7744
Practice Address - Fax:214-824-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8203207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty