Provider Demographics
NPI:1922263565
Name:STONEBRIDGE ADULT MEDICINE PA
Entity Type:Organization
Organization Name:STONEBRIDGE ADULT MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUI
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-415-2249
Mailing Address - Street 1:3550 PARKWOOD BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1903
Mailing Address - Country:US
Mailing Address - Phone:214-618-9715
Mailing Address - Fax:214-618-9716
Practice Address - Street 1:3550 PARKWOOD BLVD
Practice Address - Street 2:STE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1903
Practice Address - Country:US
Practice Address - Phone:214-618-9715
Practice Address - Fax:214-618-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0073RZOtherBLUECROSS BLUESHIELD
TX00Z896Medicare PIN