Provider Demographics
NPI:1023006210
Name:PACETTI, STEPHEN J (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:J
Last Name:PACETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 FORUM WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-242-0505
Mailing Address - Fax:561-242-9548
Practice Address - Street 1:1401 FORUM WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-242-0505
Practice Address - Fax:561-242-9548
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME56930207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269583900Medicaid
FL269583900Medicaid