Provider Demographics
NPI:1215128244
Name:STEVENSON, DONALD THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:THOMAS
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2208
Mailing Address - Country:US
Mailing Address - Phone:210-546-1400
Mailing Address - Fax:210-546-1409
Practice Address - Street 1:4680 LOCKHILL SELMA RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2094
Practice Address - Country:US
Practice Address - Phone:210-546-1880
Practice Address - Fax:210-447-6426
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06791363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherUPIN
TX2855207-01Medicaid