Provider Demographics
NPI:1649595182
Name:BEFELER, ADAM ROSS (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:ROSS
Last Name:BEFELER
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 1:603 7TH ST S
Mailing Address - Street 2:540
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4719
Mailing Address - Country:US
Mailing Address - Phone:727-828-8400
Mailing Address - Fax:727-828-8401
Practice Address - Street 1:603 7TH ST S
Practice Address - Street 2:SUITE 540
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4719
Practice Address - Country:US
Practice Address - Phone:727-828-8400
Practice Address - Fax:727-828-8401
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127779207T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271117600Medicaid
FL593681325OtherTAX ID
FL593681325OtherTAX ID