Healthcare Provider Details

I. General information

NPI: 1700084522
Provider Name (Legal Business Name): KYLE WAYNE STEPHENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 SPACE PARK DR SUITE 100
HOUSTON TX
77058-3600
US

IV. Provider business mailing address

2060 SPACE PARK DR SUITE 100
HOUSTON TX
77058-3600
US

V. Phone/Fax

Practice location:
  • Phone: 281-333-1703
  • Fax: 281-333-5970
Mailing address:
  • Phone: 281-333-1703
  • Fax: 281-333-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberP7575
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116016495
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP7575
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: