Provider Demographics
NPI:1922181064
Name:STEPHENS, LEONORA (MD)
Entity Type:Individual
Prefix:
First Name:LEONORA
Middle Name:
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 1:6350 LYNDON B JOHNSON FWY STE 252
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6402
Mailing Address - Country:US
Mailing Address - Phone:972-934-0300
Mailing Address - Fax:
Practice Address - Street 1:6350 LYNDON B JOHNSON FWY STE 252
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6402
Practice Address - Country:US
Practice Address - Phone:972-934-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG40562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC22242Medicare UPIN
TX00BG65Medicare ID - Type Unspecified