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General NPI Number Information
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NPI Number | 1124020375
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Entity Type | Organization
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Legal Business Name | STEPHEN A UPDEGRAFF MD PA
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 1601 38TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33713-1926
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Country | US
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Telephone | 727-822-4287
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Fax | 727-822-1086
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Provider Business Mailing Address
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Address Line | 1601 38TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33713-1926
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Country | US
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Telephone | 727-822-4287
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Fax | 727-822-1086
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEPHEN UPDEGRAFF
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Credential | MD
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Telephone | 727-822-4287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | ME67224
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 1171
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License Number State | FL
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