MEDICARE: STEPHEN GREENFIELD PA

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	363AM0700X	Medical Physician Assistant	PA00689	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	TXB152755	OTHER		WELLMED MEDICAL GROUP PA

General Provider Information

NPI Number	:	1568469203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN GREENFIELD PA

Provider Business Mailing Address
First Line	:	430 W SUNSET RD STE 201
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1772
Country	:	US
Telephone Number	:	210-824-4584
Fax Number	:	210-805-8466

Provider Business Practice Location Address
First Line	:	430 W SUNSET RD STE 201
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1772
Country	:	US
Telephone Number	:	210-824-4584
Fax Number	:	210-805-8466

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/30/2020

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Directions to “ STEPHEN GREENFIELD PA” Practice Location

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