Individual
IGNATIUS PAUL DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 CITYWEST BLVD, STE. 300, HOUSTON, TX 77042-2300
(713) 620-4000
(713) 458-4229
Mailing address
PO BOX 650865, DALLAS, TX 75265-0865
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G1887
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050041650
RAILROAD MEDICARE
TX
05
—
128192503
—
TX
05
—
1543781
—
LA
01
—
84Y539
TX-BLUE SHIELD
—
Enumeration date
01/09/2007
Last updated
02/23/2017
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