Provider Demographics
NPI:1467511428
Name:OH, STEPHEN S (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:S
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:341 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114
Mailing Address - Country:US
Mailing Address - Phone:386-258-6455
Mailing Address - Fax:386-248-2243
Practice Address - Street 1:341 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-258-6455
Practice Address - Fax:386-248-2243
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME472222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035494500Medicaid
64560Medicare ID - Type Unspecified
FL035494500Medicaid