Individual
STEPHEN S. IM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12500 JUDSON RD STE 205, LIVE OAK, TX 78233-4146
(210) 655-6400
(210) 655-6404
Mailing address
12500 JUDSON RD STE 205, LIVE OAK, TX 78233-4146
(210) 655-6400
(210) 655-6404
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
J4232
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105321702
—
TX
05
—
105321704
—
TX
Enumeration date
07/26/2006
Last updated
06/14/2024
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