Healthcare Provider Details

I. General information

NPI: 1619932944
Provider Name (Legal Business Name): STEPHEN H ARMISTEAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 JENKS AVE UNIT 5
PANAMA CITY FL
32405-4909
US

IV. Provider business mailing address

PO BOX 97
LYNN HAVEN FL
32444-0097
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-3635
  • Fax: 850-763-4448
Mailing address:
  • Phone: 850-763-3635
  • Fax: 850-763-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME92110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: