Healthcare Provider Details

I. General information

NPI: 1073928958
Provider Name (Legal Business Name): STEPHEN BAIRD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 S US HIGHWAY 75
DENISON TX
75020-4584
US

IV. Provider business mailing address

PO BOX 20236
BEAUMONT TX
77720-0236
US

V. Phone/Fax

Practice location:
  • Phone: 903-416-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10050865
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberR2277
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: