Provider Demographics
NPI:1669555892
Name:EFFREN, STEVEN COREY (DPM)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:COREY
Last Name:EFFREN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17820 SE 109TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8968
Mailing Address - Country:US
Mailing Address - Phone:352-347-3338
Mailing Address - Fax:352-347-3389
Practice Address - Street 1:17820 SE 102 AVE #102
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491
Practice Address - Country:US
Practice Address - Phone:352-347-3338
Practice Address - Fax:352-347-3389
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2839213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340115400Medicaid
U80733Medicare UPIN
FL340115400Medicaid