Provider Demographics
NPI:1831172832
Name:VANCURA, STEPHEN J (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:VANCURA
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:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-634-6995
Practice Address - Street 1:2201 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-634-6999
Practice Address - Fax:254-634-6995
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF90512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80590ROtherMEDICARE PN
TX80594ROtherBLUE CROSS BLUE SHIELD
TX137836610OtherSUPERIOR CHIPS
TX137836610Medicaid
TX742736914002OtherHUMANA/MILITARY-TRICARE
TX30055061OtherMEDICARE RAILROAD
E76988OtherMEDICARE UPIN