Provider Demographics
NPI:1215255146
Name:STEPINOFF, RYAN SAMUEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:SAMUEL
Last Name:STEPINOFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14800 QUARUM DRIVE, SUITE 560
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-3175
Mailing Address - Country:US
Mailing Address - Phone:713-703-9852
Mailing Address - Fax:
Practice Address - Street 1:14800 QUORUM DRIVE, SUITE 560
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-3111
Practice Address - Country:US
Practice Address - Phone:972-572-5000
Practice Address - Fax:972-572-9448
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17487375363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical