Healthcare Provider Details

I. General information

NPI: 1598144735
Provider Name (Legal Business Name): ELIZABETH DESTEPHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 HIGH STAR DR
HOUSTON TX
77074-5005
US

IV. Provider business mailing address

6445 HIGH STAR DR
HOUSTON TX
77074-5005
US

V. Phone/Fax

Practice location:
  • Phone: 713-777-1117
  • Fax:
Mailing address:
  • Phone: 713-777-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME177024
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: