Provider Demographics
NPI:1700084522
Name:STEPHENS, KYLE WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WAYNE
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2060 SPACE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3600
Mailing Address - Country:US
Mailing Address - Phone:281-333-1703
Mailing Address - Fax:281-333-5970
Practice Address - Street 1:2060 SPACE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3600
Practice Address - Country:US
Practice Address - Phone:281-333-1703
Practice Address - Fax:281-333-5970
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP7575207RC0200X, 208600000X
VA0116016495390200000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GD970OtherBCBS
TXP01355059OtherRR MEDICARE
TX337186601Medicaid
TX337186602Medicaid
TXP01355059OtherRR MEDICARE
TX337186602Medicaid
TX321003YMVQMedicare PIN