MEDICARE: DR. STEPHEN G PELHAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME36812	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	80124988	OTHER	FL	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	51125	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1073508206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN G PELHAM MD

Provider Business Mailing Address
First Line	:	3909 E BAY DR
Second Line	:	SUITE 100
City	:	HOLMES BEACH
State	:	FL
Zip	:	34217-1997
Country	:	US
Telephone Number	:	941-778-1007
Fax Number	:	941-778-9256

Provider Business Practice Location Address
First Line	:	3909 E BAY DR
Second Line	:	SUITE 100
City	:	HOLMES BEACH
State	:	FL
Zip	:	34217-1997
Country	:	US
Telephone Number	:	941-778-1007
Fax Number	:	941-778-9256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	03/31/2014

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