Provider Demographics
NPI:1770738502
Name:STEPHEN B TRAMMELL, DO, PA
Entity type:Organization
Organization Name:STEPHEN B TRAMMELL, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TRAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-617-6376
Mailing Address - Street 1:675 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1669
Mailing Address - Country:US
Mailing Address - Phone:972-617-6376
Mailing Address - Fax:
Practice Address - Street 1:675 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-1669
Practice Address - Country:US
Practice Address - Phone:972-617-6376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty