Provider Demographics
NPI:1033162003
Name:FLOORE, STEPHEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:FLOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 4TH ST SE
Mailing Address - Street 2:P.O. BOX 179
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-3064
Mailing Address - Country:US
Mailing Address - Phone:229-377-7661
Mailing Address - Fax:229-377-6832
Practice Address - Street 1:950 4TH ST SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-3064
Practice Address - Country:US
Practice Address - Phone:229-377-7661
Practice Address - Fax:229-377-6832
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017521208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39865Medicare UPIN