Individual
MR. BRADLEY STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2141 HAMILTON WAY, STE. 100, SAN ANGELO, TX 76904
(325) 245-4000
Mailing address
2141 HAMILTON WAY, STE. 100, SAN ANGELO, TX 76904
(325) 245-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03638
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182239701
—
TX
01
—
8N8582
BLUE CROSS
TX
Enumeration date
04/07/2006
Last updated
01/08/2011
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