Provider Demographics
NPI:1659342798
Name:SGAN, STEPHEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:SGAN
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 1:1899 EIDER CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4537
Mailing Address - Country:US
Mailing Address - Phone:850-878-5143
Mailing Address - Fax:850-942-6622
Practice Address - Street 1:1899 EIDER CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4537
Practice Address - Country:US
Practice Address - Phone:850-878-5143
Practice Address - Fax:850-942-6622
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87459207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267184100Medicaid
FLME87459OtherFL MEDICAL EXAMINER LICEN
FLP00119537OtherRAILROAD MEDICARE
FL71243OtherBCBS INDIVIDUAL ID#
FL71243OtherBCBS INDIVIDUAL ID#
FLH85648Medicare UPIN