Provider Demographics
NPI:1144713736
Name:MARCO, STEFANIE JANINE (MD)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:JANINE
Last Name:MARCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:JANINE
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4200 SOUTH FWY STE 1990
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-1415
Mailing Address - Country:US
Mailing Address - Phone:682-990-6491
Mailing Address - Fax:877-675-3246
Practice Address - Street 1:1631 11TH STREET
Practice Address - Street 2:UNIT B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-7630
Practice Address - Country:US
Practice Address - Phone:940-263-3000
Practice Address - Fax:940-263-3018
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU1329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine