Healthcare Provider Details

I. General information

NPI: 1790765592
Provider Name (Legal Business Name): GREGORY LEE STAMPER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SW 7TH ST
WILLISTON FL
32696-2404
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 352-528-5801
  • Fax: 352-528-6019
Mailing address:
  • Phone: 321-332-6947
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS5742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: