Provider Demographics
NPI:1376681619
Name:PRIBIL, STEFAN G (MD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:G
Last Name:PRIBIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:139 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5031
Mailing Address - Country:US
Mailing Address - Phone:772-878-5787
Mailing Address - Fax:772-673-3347
Practice Address - Street 1:139 SW PORT ST LUCIE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5031
Practice Address - Country:US
Practice Address - Phone:772-878-5787
Practice Address - Fax:772-673-3347
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA09098R207T00000X
CAG87914207T00000X
FLME97619207T00000X
TXM5448207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery