Healthcare Provider Details

I. General information

NPI: 1902883200
Provider Name (Legal Business Name): STEPHEN PATRICK GRIFFITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 S ATLANTIC AVE APT 111A
NEW SMYRNA BEACH FL
32169-3761
US

IV. Provider business mailing address

PO BOX 541162
MERRITT ISLAND FL
32954-1162
US

V. Phone/Fax

Practice location:
  • Phone: 321-514-1774
  • Fax:
Mailing address:
  • Phone: 321-514-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberME93277
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License NumberME93277
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME93277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: