Individual
LAURENCE GLENN STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240-6533
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 650865, DALLAS, TX 75265-0865
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
519791
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119932503
—
TX
05
—
119932504
—
TX
05
—
119932509
—
TX
01
—
8349UG
BCBS
TX
01
—
P01446760
RR
TX
Enumeration date
02/08/2006
Last updated
10/30/2015
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