Provider Demographics
NPI:1619074622
Name:STEPHENSON, DONALD JOE (PA)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JOE
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1701 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3043
Mailing Address - Country:US
Mailing Address - Phone:325-677-6219
Mailing Address - Fax:325-677-0129
Practice Address - Street 1:1701 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3043
Practice Address - Country:US
Practice Address - Phone:325-677-6219
Practice Address - Fax:325-677-0129
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03027363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094750901Medicaid
TX970024360OtherRAILROAD MEDICARE
TX89N525OtherBLUE CROSS BLUE SHIELD OF TEXAS
TXH38263Medicare UPIN