Healthcare Provider Details

I. General information

NPI: 1467456426
Provider Name (Legal Business Name): STEPHEN DAVID GELFOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DR. MCHE- ZQQ
JBSA FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DR. MCHE- ZQQ
JBSA FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-915-5503
  • Fax:
Mailing address:
  • Phone: 210-916-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE9653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: