Provider Demographics
NPI:1881784221
Name:ACKER, STEPHEN EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EUGENE
Last Name:ACKER
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 1:104 BELFALLS
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4941
Mailing Address - Country:US
Mailing Address - Phone:512-864-3137
Mailing Address - Fax:512-868-3157
Practice Address - Street 1:104 BELFALLS
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4941
Practice Address - Country:US
Practice Address - Phone:512-864-3137
Practice Address - Fax:512-868-3157
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86822085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D34321Medicare UPIN