Individual
STEPHEN MICHAEL WOLFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00465
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118383
NBSTSA BOARD CERTIFICATION
—
01
—
12678978
CAQH
TX
01
—
81NN10
BCBSTX
TX
01
—
SA00465
LICENSE
TX
Enumeration date
02/11/2010
Last updated
11/07/2018
Update your record
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