MEDICARE: JACQUELINE DA SILVA STEPHEN MD

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	207Q00000X	Family Medicine Physician	H5683	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659595403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE DA SILVA STEPHEN MD

Provider Business Mailing Address
First Line	:	2835 GRAND AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-1647
Country	:	US
Telephone Number	:	214-421-1783
Fax Number	:	214-421-8224

Provider Business Practice Location Address
First Line	:	2835 GRAND AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-1647
Country	:	US
Telephone Number	:	214-421-1783
Fax Number	:	214-421-8224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	11/25/2013

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