Provider Demographics
NPI:1073573580
Name:RITTER, STEPHEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:RITTER
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 1:885 37TH PL STE B
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6564
Mailing Address - Country:US
Mailing Address - Phone:772-567-6140
Mailing Address - Fax:772-567-6170
Practice Address - Street 1:885 37TH PL STE B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6564
Practice Address - Country:US
Practice Address - Phone:772-567-6140
Practice Address - Fax:772-567-6170
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23309OtherBLUE CROSS
FL268720800Medicaid
FL23309TMedicare PIN
FL23309UMedicare ID - Type Unspecified