Healthcare Provider Details

I. General information

NPI: 1730493206
Provider Name (Legal Business Name): STEPHEN MICHAEL CLARE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BROADWAY ST
SAN ANTONIO TX
78209-5708
US

IV. Provider business mailing address

5000 BROADWAY ST
SAN ANTONIO TX
78209-5708
US

V. Phone/Fax

Practice location:
  • Phone: 210-930-4500
  • Fax:
Mailing address:
  • Phone: 210-930-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number663904
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: