Provider Demographics
NPI:1710122015
Name:STEPHANIE A STOVER MD PA
Entity Type:Organization
Organization Name:STEPHANIE A STOVER MD PA
Other - Org Name:SOUTHBEACH AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-903-0093
Mailing Address - Street 1:1000 LINCOLN RD
Mailing Address - Street 2:STE. 240
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2500
Mailing Address - Country:US
Mailing Address - Phone:305-903-0093
Mailing Address - Fax:305-673-8230
Practice Address - Street 1:1000 LINCOLN RD
Practice Address - Street 2:STE. 240
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2500
Practice Address - Country:US
Practice Address - Phone:305-903-0093
Practice Address - Fax:305-673-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82217208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty