Provider Demographics
NPI:1477949212
Name:STEGBAUER, KEITH (NBC-HIS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:STEGBAUER
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 62ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-7338
Mailing Address - Country:US
Mailing Address - Phone:727-522-3692
Mailing Address - Fax:727-399-2920
Practice Address - Street 1:1598 62ND AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-7338
Practice Address - Country:US
Practice Address - Phone:727-522-3692
Practice Address - Fax:727-399-2920
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4389237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist