Provider Demographics
NPI:1821087461
Name:STEADMAN, BRENT MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:MICHAEL
Last Name:STEADMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 CENTRAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2350
Mailing Address - Country:US
Mailing Address - Phone:325-692-0212
Mailing Address - Fax:325-692-0214
Practice Address - Street 1:6450 CENTRAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2350
Practice Address - Country:US
Practice Address - Phone:325-692-0212
Practice Address - Fax:325-692-0214
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5221208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011899202Medicaid
TX118992003Medicaid
TX86Y906Medicare ID - Type Unspecified
G65808Medicare UPIN