Provider Demographics
NPI:1225102783
Name:STRAIT, STEPHEN M (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:STRAIT
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 1:1009 W BAKER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4431
Mailing Address - Country:US
Mailing Address - Phone:813-759-1232
Mailing Address - Fax:813-754-0430
Practice Address - Street 1:1009 W BAKER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4431
Practice Address - Country:US
Practice Address - Phone:813-759-1232
Practice Address - Fax:813-754-0430
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-7599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271642900Medicaid
FLOS-7599OtherLICENSE
FLOS-7599OtherLICENSE
E2323XMedicare ID - Type Unspecified