Healthcare Provider Details

I. General information

NPI: 1003350109
Provider Name (Legal Business Name): DR. STEPHEN SCOTT GRABNER II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WILFORD HALL AMBULATORY SURGICAL CENTER 1100 WILFORD HALL LOOP
JBSA-LACKLAND TX
78236
US

IV. Provider business mailing address

18230 E SILVER CREEK AVE BLDG 392
BUCKLEY AFB CO
80011-9501
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-2448
  • Fax:
Mailing address:
  • Phone: 720-847-6451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06297
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: