1033364997 NPI number — MR. PAUL GREGORY STEPHENSON MS, F-AAA

Table of content: MR. PAUL GREGORY STEPHENSON MS, F-AAA (NPI 1033364997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033364997 NPI number — MR. PAUL GREGORY STEPHENSON MS, F-AAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENSON
Provider First Name:
PAUL
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, F-AAA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033364997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 W HIGGINS RD
Provider Second Line Business Mailing Address:
SUITE 895
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60169-2071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-843-1900
Provider Business Mailing Address Fax Number:
847-843-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 NE ALSBURY BLVD
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-2668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-426-4318
Provider Business Practice Location Address Fax Number:
817-426-0127
Provider Enumeration Date:
11/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  50572 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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