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General NPI Number Information
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NPI Number | 1306342431
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Entity Type | Individual
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Provider Name | STEPHEN WESLEY LINE DO
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Gender | Male
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 3121 UNIVERSITY DR E STE 100
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City | BRYAN
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State | TX
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Zip | 77802-3499
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Country | US
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Telephone | 979-776-0169
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Fax |
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Provider Business Mailing Address
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Address Line | 8441 STATE HWY 47 STE 3115
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City | BRYAN
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State | TX
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Zip | 77807
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Country | US
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Telephone | 979-436-9703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S6243
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | BP10063117
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License Number State | TX
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