Individual
SCOTT STEGALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5414 S BROADWAY AVE, TYLER, TX 75703-1335
(903) 581-1601
(903) 581-1638
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01268
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337197302
—
TX
05
—
337197303
—
TX
01
—
8780MD
BCBS
TX
01
—
8854MB
BCBS
TX
01
—
P01811499
RAIL ROAD MEDICARE
TX
01
—
P01811994
RAIL ROAD MEDICARE
TX
Enumeration date
11/17/2005
Last updated
07/17/2017
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