Provider Demographics
NPI:1033177662
Name:EPSTEIN, SANFORD M (DO)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:M
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BAY BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4470
Mailing Address - Country:US
Mailing Address - Phone:850-934-3920
Mailing Address - Fax:850-934-3922
Practice Address - Street 1:105 BAY BRIDGE DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561
Practice Address - Country:US
Practice Address - Phone:850-934-3920
Practice Address - Fax:850-934-3922
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3562207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
81983Medicare ID - Type Unspecified
D84665Medicare UPIN