Provider Demographics
NPI:1871979674
Name:SOUDERS, STEVEN ROBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ROBERT
Last Name:SOUDERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 GABLES CT STE 201
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7648
Mailing Address - Country:US
Mailing Address - Phone:469-326-5115
Mailing Address - Fax:469-326-5119
Practice Address - Street 1:5400 HIGHWAY 121 STE 100
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5929
Practice Address - Country:US
Practice Address - Phone:817-502-7411
Practice Address - Fax:817-502-7412
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TXPA09955207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8874NVOtherBCBS
TX8874NVOtherBCBS