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General NPI Number Information
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NPI Number | 1457324782
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Entity Type | Individual
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Provider Name | JAMES S DISTEFANO DO
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 3201 UNIVERSITY DR E STE 320
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City | BRYAN
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State | TX
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Zip | 77802-3478
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Country | US
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Telephone | 979-704-5029
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 UNIVERSITY DR E STE 320
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City | BRYAN
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State | TX
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Zip | 77802-3478
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Country | US
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Telephone | 979-704-5029
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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 | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | M7149
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License Number State | TX
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