Provider Demographics
NPI:1144252925
Name:STEPHEN T. ENGUIDANOS, MD
Entity type:Organization
Organization Name:STEPHEN T. ENGUIDANOS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENGUIDANOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-729-1444
Mailing Address - Street 1:1110 JUNIPER AVENUE
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2218
Mailing Address - Country:US
Mailing Address - Phone:850-729-1444
Mailing Address - Fax:850-729-0300
Practice Address - Street 1:1110 JUNIPER AVENUE
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2218
Practice Address - Country:US
Practice Address - Phone:850-729-1444
Practice Address - Fax:850-729-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDR3144OtherRAILROAD MEDICARE
FLDR3144OtherRAILROAD MEDICARE
FLK8782Medicare PIN
FL6191360001Medicare NSC