Basic Information
| Provider Information | |||||||||
| NPI: | 1548230840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STEPHENS | ||||||||
| OtherFirstName: | EDWARD | ||||||||
| OtherMiddleName: | MICHAEL | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8410 W BARTELL DR | ||||||||
| Address2: | #708 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138391056 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1325 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | ROCKPORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783823333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617290646 | ||||||||
| FaxNumber: | 3617298854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | F2042 | TX | X | Allopathic & Osteopathic Physicians | Emergency Medicine | 208600000X | F2042 | TX | X | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.