Healthcare Provider Details

I. General information

NPI: 1437127958
Provider Name (Legal Business Name): STEWART W STEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12470 TELECOM DR STE 300W
TEMPLE TERRACE FL
33637-0904
US

IV. Provider business mailing address

12470 TELECOM DR STE 300W
TEMPLE TERRACE FL
33637-0904
US

V. Phone/Fax

Practice location:
  • Phone: 813-871-8111
  • Fax: 813-871-8028
Mailing address:
  • Phone: 813-871-8111
  • Fax: 813-871-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME108439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: