Provider Demographics
NPI:1710959002
Name:CALVIN, STEPHEN JO (DO)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JO
Last Name:CALVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 EAST BLUEBIRD COURT
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442
Mailing Address - Country:US
Mailing Address - Phone:352-201-2758
Mailing Address - Fax:
Practice Address - Street 1:1292 EAST BLUEBIRD COURT
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442
Practice Address - Country:US
Practice Address - Phone:352-201-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS45002083P0901X
FLOS0004500208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069172100Medicaid
E32261Medicare UPIN
FL069172100Medicaid