Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Jack B Stephenson IV, MD

Individual provider Surgery of the Hand (Plastic Surgery) Physician · NPI 1972624542

Dr. Jack B Stephenson IV, MD is a Plastic and Reconstructive Surgery in Tyler, Texas. Graduated from Baylor College of Medicine in 2007, 19 years ago. Practices with Christus Trinity Clinic, a 1,531-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
19
Trained at
Baylor College of Medicine
Licensed in
TX
In the registry since
2007
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

8591 S Broadway Ave
Tyler, TX 75703-5470
Phone: (903) 596-9173
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 23960 Katy Freeway, Katy, TX 77494 — (832) 232-4263
  • 1327 Troup Hwy, Tyler, TX 75701-4443 — (903) 606-8840

Specialties & licences

Surgery of the Hand (Plastic Surgery) Physician (primary) Taxonomy 2082S0105X · Licence P5238 (TX)

Record details

NPI number1972624542
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 2, 2007
Last updated in NPPESNovember 19, 2024
Certification dateNovember 19, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPLASTIC AND RECONSTRUCTIVE SURGERY
Also practisesHAND SURGERY
Medical schoolBAYLOR COLLEGE OF MEDICINE
Graduated 2007 (19 years in practice)
Group practice Christus Trinity Clinic — 1531 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare