Healthcare Provider Details

I. General information

NPI: 1346298890
Provider Name (Legal Business Name): STEPHEN MARK OLMSTEAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 N SHILOH RD
GARLAND TX
75042-5714
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 972-272-4463
  • Fax: 972-272-7137
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberJ8336
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: