Provider Demographics
NPI:1548353634
Name:LAI, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:LAI
Suffix:
Gender:M
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2140
Practice Address - Fax:817-332-2506
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG91402080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX10028569OtherAMERIGROUP PIN
TX1640397OtherFIRSTHEALTH PIN
1750369203OtherGRP NPI NUMBER
TX137345810Medicaid
TX1387826OtherUHC PIN
TX137567705Medicaid
TX140442852Medicaid
TX4227558OtherAETNA PIN
TX112498OtherSUPERIOR PIN
TX117277100OtherFIRSTCARE PIN
TX87Z124OtherBCBSTX IND PIN
TX0917266OtherCIGNA PIN
TX137567707Medicaid
TX112498OtherSUPERIOR PIN
TX137567705Medicaid
TX140442852Medicaid