Provider Demographics
NPI:1144300633
Name:BRUCE, STEPHANIE SWAFFORD (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SWAFFORD
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13215 DOTSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4535
Mailing Address - Country:US
Mailing Address - Phone:281-444-3440
Mailing Address - Fax:281-444-4080
Practice Address - Street 1:10130 LOUETTA RD STE G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:832-698-5525
Practice Address - Fax:832-698-5526
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5709207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149151601Medicaid
TXH47425Medicare UPIN
TX8574N0Medicare ID - Type Unspecified