Healthcare Provider Details

I. General information

NPI: 1922161561
Provider Name (Legal Business Name): STEPHANIE PAIGE CRUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR SUITE 390
OCOEE FL
34761-3400
US

IV. Provider business mailing address

10000 W COLONIAL DR SUITE 390
OCOEE FL
34761-3400
US

V. Phone/Fax

Practice location:
  • Phone: 407-290-2394
  • Fax: 407-521-3640
Mailing address:
  • Phone: 407-290-2394
  • Fax: 407-521-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME73314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: