Provider Demographics
NPI:1285693382
Name:STEPONAITIS, GLENN EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:EDWARD
Last Name:STEPONAITIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7610 STEMMONS FWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4231
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:214-630-7293
Practice Address - Street 1:2909 S HAMPTON RD
Practice Address - Street 2:E225 LB16
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3000
Practice Address - Country:US
Practice Address - Phone:214-467-8302
Practice Address - Fax:214-467-8538
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84P422Medicare PIN
TXP73810Medicare UPIN
TX970028886Medicare PIN