Healthcare Provider Details

I. General information

NPI: 1689762080
Provider Name (Legal Business Name): STEPHEN THOMAS SEWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD
GAINESVILLE FL
32605-4309
US

IV. Provider business mailing address

1510 NW 107TH TER 2905
GAINESVILLE FL
32606-5768
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4000
  • Fax:
Mailing address:
  • Phone: 352-332-3893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN10009
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME104833
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: