MEDICARE: STEPHEN L DEMETER PARAMEDIC

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
1	146L00000X	Paramedic	0800782	AL

General Provider Information

NPI Number	:	1720304454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN L DEMETER PARAMEDIC

Provider Business Mailing Address
First Line	:	1370 SANIBEL LN
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-2585
Country	:	US
Telephone Number	:	850-501-6046
Fax Number	:

Provider Business Practice Location Address
First Line	:	8360 3RD AVE
Second Line	:
City	:	FORT RUCKER
State	:	AL
Zip	:	36362-2025
Country	:	US
Telephone Number	:	334-255-0456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/20/2010

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