Healthcare Provider Details

I. General information

NPI: 1710959002
Provider Name (Legal Business Name): STEPHEN JO CALVIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 EAST BLUEBIRD COURT
HERNANDO FL
34442
US

IV. Provider business mailing address

1292 EAST BLUEBIRD COURT
HERNANDO FL
34442
US

V. Phone/Fax

Practice location:
  • Phone: 352-201-2758
  • Fax:
Mailing address:
  • Phone: 352-201-2758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberOS4500
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS0004500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: