Individual
JEFFREY S STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4450 TUBBS RD, ROCKWALL, TX 75032-6308
(972) 722-3290
(972) 722-3815
Mailing address
4450 TUBBS RD, ROCKWALL, TX 75032-6308
(972) 722-3290
(972) 722-3815
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J2983
TX
208600000X
Surgery Physician
J2983
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0999351
AMERIGROUP
TX
05
—
099935106
—
TX
01
—
1093083560
GRP NPI
TX
01
—
265403YN0Q
MCPTAN
TX
01
—
36-412381
TIN #
TX
01
—
J2983
TEXAS LICENSE
TX
01
—
P01153365
RR MEDICARE
TX
Enumeration date
05/06/2006
Last updated
10/30/2015
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