Provider Demographics
NPI:1265539688
Name:MCCAIN, STEFANIE BERTIE (MD)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:BERTIE
Last Name:MCCAIN
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 1:19 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5269
Mailing Address - Country:US
Mailing Address - Phone:325-690-0620
Mailing Address - Fax:325-690-0622
Practice Address - Street 1:19 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5269
Practice Address - Country:US
Practice Address - Phone:325-690-0620
Practice Address - Fax:325-690-0622
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0123207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0899221-01Medicaid
TX0899221-01Medicaid
TX0899221-01Medicaid