MEDICARE: MARK SAM STERN M.D.

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	207R00000X	Internal Medicine Physician	ME 33074	FL

General Provider Information

NPI Number	:	1679538425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK SAM STERN M.D.

Provider Business Mailing Address
First Line	:	5210 INTERBAY BLVD
Second Line	:	APT 9
City	:	TAMPA
State	:	FL
Zip	:	33611-4145
Country	:	US
Telephone Number	:	813-334-2795
Fax Number	:	813-287-0671

Provider Business Practice Location Address
First Line	:	5210 INTERBAY BLVD
Second Line	:	APT 9
City	:	TAMPA
State	:	FL
Zip	:	33611-4145
Country	:	US
Telephone Number	:	813-334-2795
Fax Number	:	813-287-0671

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	06/15/2016

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