MEDICARE: ELIAS STEPHAN 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	L4734	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7362515	OTHER	TX	AETNA PROVIDER ID NUMBER
2	8V4810	OTHER	TX	BCBS PIN
3	05086764	OTHER	TX	ECFMG NUMBER

General Provider Information

NPI Number	:	1811981996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIAS STEPHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 18797
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77496-8797
Country	:	US
Telephone Number	:	281-980-1899
Fax Number	:	281-980-1914

Provider Business Practice Location Address
First Line	:	15200 SOUTHWEST FWY
Second Line	:	230
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3845
Country	:	US
Telephone Number	:	281-980-1899
Fax Number	:	855-360-9600

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	04/24/2023

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Directions to “ ELIAS STEPHAN MD” Practice Location

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