Healthcare Provider Details

I. General information

NPI: 1285893065
Provider Name (Legal Business Name): SCOTT M STENGEL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 W DIXIE AVE
LEESBURG FL
34748-6312
US

IV. Provider business mailing address

1112 W DIXIE AVE
LEESBURG FL
34748-6312
US

V. Phone/Fax

Practice location:
  • Phone: 352-728-5857
  • Fax: 352-728-6734
Mailing address:
  • Phone: 352-728-5857
  • Fax: 352-728-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME61419
License Number StateFL

VIII. Authorized Official

Name: SCOTT M STENGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 352-728-5857