Provider Demographics
NPI:1548235633
Name:HOUSTON, STEPHEN DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4419 FRONTIER TRL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1686
Mailing Address - Country:US
Mailing Address - Phone:512-444-7208
Mailing Address - Fax:512-444-2343
Practice Address - Street 1:4419 FRONTIER TRL
Practice Address - Street 2:SUITE 110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1686
Practice Address - Country:US
Practice Address - Phone:512-444-7208
Practice Address - Fax:512-444-2343
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1198207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122735702Medicaid