Healthcare Provider Details

I. General information

NPI: 1205868437
Provider Name (Legal Business Name): WILLIAM JOHN STEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 VERNON PLACE SOUTH
MELBOURNE FL
32901
US

IV. Provider business mailing address

2065 HIGHWAY A1A UNIT 1501
INDIAN HARBOUR BEACH FL
32937
US

V. Phone/Fax

Practice location:
  • Phone: 321-951-9300
  • Fax: 321-951-9320
Mailing address:
  • Phone: 321-777-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number091665
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number99179
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number091665-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: