Healthcare Provider Details

I. General information

NPI: 1548221104
Provider Name (Legal Business Name): STEPHAN A BART SR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S APOPKA AVE
INVERNESS FL
34452-4803
US

IV. Provider business mailing address

204 S APOPKA AVE
INVERNESS FL
34452-4803
US

V. Phone/Fax

Practice location:
  • Phone: 352-341-1159
  • Fax: 352-341-2718
Mailing address:
  • Phone: 352-341-1159
  • Fax: 352-341-2718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME64842
License Number StateFL

VIII. Authorized Official

Name: STEPHAN A BART SR.
Title or Position: PRESIDENT
Credential: MD
Phone: 352-341-1159