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NPI Code Detail

MEDICARE: DR. STEPHANIE A. DEVERICK M.D.

MEDICARE: DR. STEPHANIE A. DEVERICK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianME22306FL

General Provider Information

NPI Number : 1558368761
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHANIE A. DEVERICK M.D.
Provider Business Mailing Address
First Line : PO BOX 5002
Second Line :
City : TARPON SPRINGS
State : FL
Zip : 34688-5002
Country : US
Telephone Number : 727-943-3116
Fax Number :
Provider Business Practice Location Address
First Line : 43309 US HIGHWAY 19 N
Second Line :
City : TARPON SPRINGS
State : FL
Zip : 34689-6221
Country : US
Telephone Number : 727-943-3116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 07/13/2007

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