MEDICARE: GLENN EDWARD STEPONAITIS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA03454	TX

General Provider Information

NPI Number	:	1285693382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN EDWARD STEPONAITIS PA-C

Provider Business Mailing Address
First Line	:	7610 STEMMONS FWY
Second Line	:	SUITE 500
City	:	DALLAS
State	:	TX
Zip	:	75247-4231
Country	:	US
Telephone Number	:	214-689-5960
Fax Number	:	214-630-7293

Provider Business Practice Location Address
First Line	:	2909 S HAMPTON RD
Second Line	:	E225 LB16
City	:	DALLAS
State	:	TX
Zip	:	75224-3000
Country	:	US
Telephone Number	:	214-467-8302
Fax Number	:	214-467-8538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	05/27/2010

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Directions to “ GLENN EDWARD STEPONAITIS PA-C” Practice Location

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