MEDICARE: STEFANIE J. MCCANN MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	H8244	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48CU	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1528382041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEFANIE J. MCCANN MD PA

Provider Business Mailing Address
First Line	:	18800 PRESTON RD STE 314
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-8565
Country	:	US
Telephone Number	:	972-312-9292
Fax Number	:	972-312-9995

Provider Business Practice Location Address
First Line	:	18800 PRESTON RD STE 314
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-8565
Country	:	US
Telephone Number	:	972-312-9292
Fax Number	:	972-312-9995

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEFANIE JOY MCCANN
Credential	:	MD
Telephone Number	:	972-312-9292

Provider Enumeration Date	:	03/26/2010
Last Update Date	:	03/26/2010

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