Provider Demographics
NPI:1871547737
Name:ANDERSON, STEPHEN CARL
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CARL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 74TH CIR NE
Mailing Address - Street 2:ALL FLORIDA ORTHOPAEDIC ASSOCIATES
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4617
Mailing Address - Country:US
Mailing Address - Phone:727-526-9207
Mailing Address - Fax:727-520-8197
Practice Address - Street 1:1353 74TH CIR NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4617
Practice Address - Country:US
Practice Address - Phone:727-526-9207
Practice Address - Fax:727-520-8197
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME474642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300075304OtherRAILROAD MEDICARE
FL09657OtherBLUE CROSS BLUE SHIELD
FL063561800Medicaid
FL09657WMedicare ID - Type Unspecified
300075304OtherRAILROAD MEDICARE