Healthcare Provider Details

I. General information

NPI: 1124218037
Provider Name (Legal Business Name): JOEL D STEIN, D.O., P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 N FEDERAL HWY
FORT LAUDERDALE FL
33308-5530
US

IV. Provider business mailing address

4109 N FEDERAL HWY
FORT LAUDERDALE FL
33308-5530
US

V. Phone/Fax

Practice location:
  • Phone: 954-563-2707
  • Fax: 954-563-7009
Mailing address:
  • Phone: 954-563-2707
  • Fax: 954-563-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number601878
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number601878
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number601878
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS0004707
License Number StateFL

VIII. Authorized Official

Name: MR. RICK P WETHERINGTON
Title or Position: ADMINISTRATOR
Credential: CMBM
Phone: 954-540-1031