Healthcare Provider Details

I. General information

NPI: 1962499988
Provider Name (Legal Business Name): STUART ALAN MORGENSTEIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/13/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MILLS AVE STE C
ORLANDO FL
32803-5735
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-3655
  • Fax: 407-845-8353
Mailing address:
  • Phone: 239-424-1400
  • Fax: 239-424-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number036-062413
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOS10324
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number02003616A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: