Individual
CHAD B STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
431 E STATE HIGHWAY 114 STE 120, SOUTHLAKE, TX 76092-4416
(817) 518-1112
(817) 518-1113
Mailing address
431 E STATE HIGHWAY 114 STE 120, SOUTHLAKE, TX 76092-4416
(817) 518-1112
(817) 518-1113
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
L3143
TX
208VP0014X
Interventional Pain Medicine Physician
Primary
L3143
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148234112
—
TX
01
—
8CG731
BCBS
TX
Enumeration date
08/04/2005
Last updated
06/08/2020
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