Provider Demographics
NPI:1346212933
Name:NAOUMOFF, STEPHANE M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANE
Middle Name:M
Last Name:NAOUMOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1395 N COURTENAY PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953
Mailing Address - Country:US
Mailing Address - Phone:321-453-5252
Mailing Address - Fax:321-453-5152
Practice Address - Street 1:1395 N COURTENAY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4474
Practice Address - Country:US
Practice Address - Phone:321-453-5252
Practice Address - Fax:321-453-5152
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME818832083P0011X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113578300Medicaid
FL113538600Medicaid
H53058Medicare UPIN