Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | P5238 | TX |
N | 208600000X | Surgeon | P5238 | TX |
N | 2082S0105X | Plastic Hand Surgeon | P5238 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | P5238 | TX |
NPI | 1972624542 |
---|---|
Provider Name | Dr. Jack B Stephenson IV |
First Address | Katy, TX 77494 |
Second Address | Katy, TX 77494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 09/12/2015 |