Provider Demographics
NPI:1740567122
Name:GROFF, STEPHEN HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HENRY
Last Name:GROFF
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 1:1 BEACH DR SE UNIT 2006
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3957
Mailing Address - Country:US
Mailing Address - Phone:727-822-4676
Mailing Address - Fax:727-822-4676
Practice Address - Street 1:1 BEACH DR SE UNIT 2006
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3957
Practice Address - Country:US
Practice Address - Phone:727-822-4676
Practice Address - Fax:727-822-4676
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL159512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49811-4Medicaid
FL49811-4Medicaid