Basic Information
| Provider Information | |||||||||
| NPI: | 1558706739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | CLINTON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11503 NW MILITARY HWY STE 202 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782311895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102336363 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11503 NW MILITARY HWY STE 202 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782311895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102336363 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2013 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Q8797 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.