Provider Demographics
NPI:1255528006
Name:LUMMUS, STEPHEN F (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:LUMMUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 ALLIANCE BLVD
Mailing Address - Street 2:SUITE 810
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5340
Mailing Address - Country:US
Mailing Address - Phone:972-985-2797
Mailing Address - Fax:
Practice Address - Street 1:701 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6608
Practice Address - Country:US
Practice Address - Phone:903-315-5250
Practice Address - Fax:903-663-6371
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05476363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant