Individual
DR. THOMAS WESLEY STIDVENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3501 N 19TH ST, WACO, TX 76708-2007
(254) 756-2171
(254) 745-5119
Mailing address
8216 TEAKWOOD DR, WACO, TX 76712-2426
(254) 776-1084
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
E2879
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1287674
—
TX
Enumeration date
09/28/2006
Last updated
07/08/2007
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