Healthcare Provider Details

I. General information

NPI: 1013709468
Provider Name (Legal Business Name): STEPHANIE BLUMENSTOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DELL MEDICAL SCHOOL AT THE UNIVERSITY OF TEXAS GME OFFI 1501 RED RIVER, 2ND FLOOR
AUSTIN TX
78712
US

IV. Provider business mailing address

DELL MEDICAL SCHOOL AT THE UNIVERSITY OF TEXAS GME OFFI 1501 RED RIVER, 2ND FLOOR
AUSTIN TX
78712
US

V. Phone/Fax

Practice location:
  • Phone: 512-495-5555
  • Fax:
Mailing address:
  • Phone: 512-495-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10093750
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: