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General NPI Number Information
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NPI Number | 1285014712
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Entity Type | Individual
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Provider Name | STEPHEN DESOUZA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2015
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 7424 US HIGHWAY 64 STE 111
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City | BARTLETT
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State | TN
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Zip | 38133-8937
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Country | US
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Telephone | 901-372-3573
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 N DUNWOODIE RD
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City | AVON PARK
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State | FL
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Zip | 33825-9310
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Country | US
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Telephone | 347-583-0399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME129120
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 57359
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CO412
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21172
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License Number State | FL
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