Provider Demographics
NPI:1689645426
Name:GOLL, STEPHEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:GOLL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 WEST CRYSTAL LAKE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1049
Mailing Address - Country:US
Mailing Address - Phone:407-254-2500
Mailing Address - Fax:407-254-2557
Practice Address - Street 1:2699 LEE RD STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1738
Practice Address - Country:US
Practice Address - Phone:407-897-1363
Practice Address - Fax:407-254-2557
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0059566207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052921400Medicaid
FL11995ZMedicare ID - Type Unspecified
FL052921400Medicaid