Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 16226 | TX |
Y | 213EG0000X | General Practice | 16226 | TX |
N | 1223P0221X | Pediatric Dentist | 16226 | TX |
NPI | 1043232481 |
---|---|
Provider Name | Dr. Mark Stephenson |
First Address | Conroe, TX 77304-2800 |
Second Address | Conroe, TX 77304-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
091158801 | (05) | TX |