Provider Demographics
NPI:1518107242
Name:AARON B STEIN MD PLLC
Entity Type:Organization
Organization Name:AARON B STEIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RYSULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-475-2668
Mailing Address - Street 1:PO BOX 2266
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2266
Mailing Address - Country:US
Mailing Address - Phone:850-475-2668
Mailing Address - Fax:850-475-2669
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8633
Practice Address - Country:US
Practice Address - Phone:850-475-2668
Practice Address - Fax:850-475-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61690208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370078001Medicaid
14983OtherBCBS FL
FL370078001Medicaid