Individual
STEPHEN DEWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1010 W 40TH ST, AUSTIN, TX 78756-4010
(512) 459-8753
(512) 483-6828
Mailing address
1010 W 40TH ST, AUSTIN, TX 78756-4010
(512) 459-8753
(512) 483-6828
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
F5518
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117733902
—
TX
01
—
741796484
TAX ID NO
TX
01
—
824101
AUSTIN BCBS PROV NO
TX
01
—
85004X
SAN ANGELO BCBS PROV NO
TX
Enumeration date
07/27/2006
Last updated
07/30/2009
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