Basic Information
| Provider Information | |||||||||
| NPI: | 1790769297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENSON | ||||||||
| FirstName: | DOUGLAS | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1325 | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756711325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039276183 | ||||||||
| FaxNumber: | 9039276230 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 S GROVE ST | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756705219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039276183 | ||||||||
| FaxNumber: | 9039276230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | J3236 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.