Individual
DR. JAMES S DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3201 UNIVERSITY DR E STE 320, BRYAN, TX 77802-3478
(979) 704-5029
Mailing address
3201 UNIVERSITY DR E STE 320, BRYAN, TX 77802-3478
(979) 704-5029
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
M7149
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8AH949
BLUE CROSS
—
Enumeration date
02/08/2006
Last updated
10/10/2018
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