MEDICARE: STEPHAN ALLAN SHIVVERS MD

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	207V00000X	Obstetrics & Gynecology Physician	K1676	TX
2	207VM0101X	Maternal & Fetal Medicine Physician	K1676	TX
3	207SG0201X	Clinical Genetics (M.D.) Physician	K1676	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659338069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN ALLAN SHIVVERS MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-645-0624
Fax Number	:	214-645-0078

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7208
Country	:	US
Telephone Number	:	214-645-0624
Fax Number	:	214-645-0078

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	02/26/2026

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Directions to “ STEPHAN ALLAN SHIVVERS MD” Practice Location

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