Provider Demographics
NPI:1154401065
Name:JANECEK, STEPHEN E (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:JANECEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LANE
Mailing Address - Street 2:#200
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2194
Mailing Address - Country:US
Mailing Address - Phone:316-573-6291
Mailing Address - Fax:361-576-2434
Practice Address - Street 1:1501 E MOCKINGBIRD LANE
Practice Address - Street 2:#200
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2194
Practice Address - Country:US
Practice Address - Phone:316-573-6291
Practice Address - Fax:361-576-2434
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6311207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMDH6311OtherWORKERS COMPENSATION
TX87W114OtherBLUE CROSS
TX115106001Medicaid
TX115106003Medicaid
TX87W114OtherBLUE CROSS
TX87W114OtherBLUE CROSS
TX87W114Medicare ID - Type Unspecified