Provider Demographics
NPI:1720172265
Name:MCCANN, STEFANIE JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:JOY
Last Name:MCCANN
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 1:18800 PRESTON ROAD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252
Mailing Address - Country:US
Mailing Address - Phone:972-312-9292
Mailing Address - Fax:972-312-9995
Practice Address - Street 1:18800 PRESTON ROAD
Practice Address - Street 2:SUITE 314
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252
Practice Address - Country:US
Practice Address - Phone:972-312-9292
Practice Address - Fax:972-312-9995
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8244207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048CUOtherBCBS PROVIDER NUMBER
TX0048CUOtherBCBS PROVIDER NUMBER
TXF24407Medicare UPIN