Healthcare Provider Details

I. General information

NPI: 1720842503
Provider Name (Legal Business Name): JESSE L STEM MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 66TH ST N STE 105
PINELLAS PARK FL
33781-2101
US

IV. Provider business mailing address

7800 66TH ST N STE 105
PINELLAS PARK FL
33781-2101
US

V. Phone/Fax

Practice location:
  • Phone: 727-490-9115
  • Fax: 855-592-2984
Mailing address:
  • Phone: 540-525-9759
  • Fax: 855-592-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSE L STEM
Title or Position: OWNER
Credential: MD
Phone: 727-490-9115