Provider Demographics
NPI:1497926950
Name:STAM, CRAIG B (DPM)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:B
Last Name:STAM
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2100 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3770
Mailing Address - Country:US
Mailing Address - Phone:954-458-1248
Mailing Address - Fax:
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3765
Practice Address - Country:US
Practice Address - Phone:954-458-1248
Practice Address - Fax:954-458-1256
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO 3321213ES0103X
GAPOD001112213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery