Basic Information
| Provider Information | |||||||||
| NPI: | 1548353634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAI | ||||||||
| FirstName: | STEPHEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 COOPER ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828852140 | ||||||||
| FaxNumber: | 8173322506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | G9140 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 10028569 | 01 | TX | AMERIGROUP PIN | OTHER | 1640397 | 01 | TX | FIRSTHEALTH PIN | OTHER | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 137345810 | 05 | TX | MEDICAID | 1387826 | 01 | TX | UHC PIN | OTHER | 137567705 | 05 | TX | MEDICAID | 140442852 | 05 | TX | MEDICAID | 4227558 | 01 | TX | AETNA PIN | OTHER | 112498 | 01 | TX | SUPERIOR PIN | OTHER | 117277100 | 01 | TX | FIRSTCARE PIN | OTHER | 87Z124 | 01 | TX | BCBSTX IND PIN | OTHER | 0917266 | 01 | TX | CIGNA PIN | OTHER | 137567707 | 05 | TX | MEDICAID |