Individual provider · NPI-1

Dr. Jack B Stephenson IV, M.D.

Plastic Surgery, Surgery of the Hand · Tyler, TX

NPI number1972624542
StatusActive
Last updated in NPPESNov 19, 2024

Details

NPI
1972624542
Entity type
Individual (NPI-1)
Name
Dr. Jack B Stephenson IV
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Apr 2, 2007
Certification date
Nov 19, 2024
Last updated
Nov 19, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2082S0105X Plastic Surgery, Surgery of the HandP5238TXYes

Practice location

8591 S Broadway Ave
Tyler, TX 75703-5470

Phone 903-596-9173

Mailing address

8591 S Broadway Ave
Tyler, TX 75703-5470

Phone 903-596-9173

Other practice locations

1327 Troup Hwy
Tyler, TX 75701-4443

Phone 903-606-8840

23960 Katy Freeway
Suite 380
Katy, TX 77494

Phone 832-232-4263 · Fax 844-342-4263

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