Healthcare Provider Details

I. General information

NPI: 1104178805
Provider Name (Legal Business Name): STEVEN M HEAD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 SW 20TH PL #100
OCALA FL
34471-7881
US

IV. Provider business mailing address

1920 SW 20TH PL #100
OCALA FL
34471-7881
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-1212
  • Fax: 352-237-0066
Mailing address:
  • Phone: 352-237-1212
  • Fax: 352-237-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9106785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: