=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346212933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANE M NAOUMOFF MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2006
-----------------------------------------------------
Last Update Date | 01/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1395 N COURTENAY PKWY STE 100
-----------------------------------------------------
City | MERRITT ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32953-4474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-453-5252
-----------------------------------------------------
Fax | 321-453-5152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1395 N COURTENAY PKWY STE 100
-----------------------------------------------------
City | MERRITT ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-453-5252
-----------------------------------------------------
Fax | 321-453-5152
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0011X
-----------------------------------------------------
Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
-----------------------------------------------------
License Number | ME81883
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME81883
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------