Individual
DR. STEPHEN L JOLISSAINT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4770 REGENT BLVD, IRVING, TX 75063-2445
(972) 934-4300
(972) 455-1212
Mailing address
14275 MIDWAY RD, 400, ADDISON, TX 75001-3614
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
L9752
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192716201
—
TX
01
—
82P809
BCBS
TX
01
—
P00436464
RR MEDICARE
TX
Enumeration date
01/20/2006
Last updated
09/26/2017
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