Individual
STEPHEN BLACKSTONE EDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(210) 292-6255
(210) 292-7934
Mailing address
4481 SUGAR MAPLE DR, WRIGHT PATTERSON AFB, OH 45433-5536
(937) 257-0837
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01066091A
IN
2084P0800X
Psychiatry Physician
Primary
35.151601
OH
Other
Enumeration date
07/02/2007
Last updated
06/06/2025
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