Individual
STEPHEN ELLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1100 WILFORD HALL LOOP FL 1, JBSA LACKLAND, TX 78236-5638
(210) 292-3473
Mailing address
1100 WILFORD HALL LOOP FL 1, JBSA LACKLAND, TX 78236-5638
(210) 292-3473
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
07/16/2014
Last updated
03/24/2025
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