Individual
REBECCA KINNEY STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1500 S MAIN ST STE 303, FORT WORTH, TX 76104-4917
(817) 702-1172
(817) 702-1605
Mailing address
PO BOX 732973, DALLAS, TX 75373-7329
(817) 702-8445
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
L9503
TX
2086X0206X
Surgical Oncology Physician
L9503
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168027402
—
TX
01
—
P00254219
RAILROAD MEDICARE
—
Enumeration date
07/15/2006
Last updated
12/04/2024
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