Healthcare Provider Details

I. General information

NPI: 1033162003
Provider Name (Legal Business Name): STEPHEN L FLOORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 4TH ST SE
CAIRO GA
39828-3064
US

IV. Provider business mailing address

950 4TH ST SE P.O. BOX 179
CAIRO GA
39828-3064
US

V. Phone/Fax

Practice location:
  • Phone: 229-377-7661
  • Fax: 229-377-6832
Mailing address:
  • Phone: 229-377-7661
  • Fax: 229-377-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number017521
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: