Healthcare Provider Details

I. General information

NPI: 1558568279
Provider Name (Legal Business Name): STEPHEN M PIRRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD STE 1100
JACKSONVILLE FL
32216-5876
US

IV. Provider business mailing address

4205 BELFORT RD STE 1100
JACKSONVILLE FL
32216-5876
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-3103
  • Fax: 904-296-3106
Mailing address:
  • Phone: 904-296-3103
  • Fax: 904-296-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME103959
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number22650
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: