Healthcare Provider Details

I. General information

NPI: 1689202749
Provider Name (Legal Business Name): STEVEN PACK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 FIVAY RD
HUDSON FL
34667-7103
US

IV. Provider business mailing address

5698 N TROPICAL TRL
MERRITT ISLAND FL
32953-7203
US

V. Phone/Fax

Practice location:
  • Phone: 727-819-2966
  • Fax: 727-819-2928
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS21134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: