Provider Demographics
NPI:1407875529
Name:PASCUCCI, STEPHEN E JR (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:PASCUCCI
Suffix:JR
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 1:23451 WALDEN CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4919
Mailing Address - Country:US
Mailing Address - Phone:239-949-2021
Mailing Address - Fax:239-949-1500
Practice Address - Street 1:23451 WALDEN CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4919
Practice Address - Country:US
Practice Address - Phone:239-949-2021
Practice Address - Fax:239-949-1500
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88450207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52059Medicare PIN
C32832Medicare UPIN