=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508830761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN M GRIEPER D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2006
-----------------------------------------------------
Last Update Date | 02/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 NORTH CLYDE MORRIS BLVD
-----------------------------------------------------
City | DAYTONA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-425-4035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 E. GORE STREET
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-832-3621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | OS8704
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------