Provider Demographics
NPI:1558300897
Name:ANTHONY, STEPHEN GERALD (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GERALD
Last Name:ANTHONY
Suffix:
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 1:1601 N PALM AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3200
Mailing Address - Country:US
Mailing Address - Phone:954-438-0033
Mailing Address - Fax:954-438-4417
Practice Address - Street 1:1601 N PALM AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3200
Practice Address - Country:US
Practice Address - Phone:954-438-0033
Practice Address - Fax:954-438-4417
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 50597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51030Medicare UPIN
FL04881YMedicare PIN