Provider Demographics
NPI:1457369720
Name:STINSON, DARRYL LEE (MD)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:LEE
Last Name:STINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 E HIGHWAY BUSINESS 83
Mailing Address - Street 2:SUITE B
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572
Mailing Address - Country:US
Mailing Address - Phone:956-410-1000
Mailing Address - Fax:956-410-1021
Practice Address - Street 1:2120 E HIGHWAY BUSINESS 83
Practice Address - Street 2:SUITE B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9208
Practice Address - Country:US
Practice Address - Phone:956-410-1000
Practice Address - Fax:956-410-1021
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ7212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121195506Medicaid
TX8AN021OtherBCBS
TX121195501Medicaid
TX061781032OtherPCI TAX ID
TX742704957OtherTAX ID NUMBER
TX121195506Medicaid
8F6946Medicare PIN
TX061781032OtherPCI TAX ID