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General NPI Number Information
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NPI Number | 1760586358
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Entity Type | Individual
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Provider Name | STEPHEN JAN VANCLEAVE M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 21465 IH 10 SUITE 217-508
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1159
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Country | US
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Telephone | 210-860-2625
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Fax |
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Provider Business Mailing Address
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Address Line | 24165 IH 10 W SUITE 217-508
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1159
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Country | US
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Telephone | 210-860-2625
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E2909
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License Number State | TX
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