Provider Demographics
NPI:1750458535
Name:PLUMB, STEPHEN J (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:PLUMB
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1450 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4505
Mailing Address - Country:US
Mailing Address - Phone:855-353-7546
Mailing Address - Fax:863-294-2767
Practice Address - Street 1:421 LINDEN LN
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4342
Practice Address - Country:US
Practice Address - Phone:855-353-7546
Practice Address - Fax:863-676-1015
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS14079207ND0900X, 207ND0101X
KS530782207ND0900X
MO2004011010207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSI14041Medicare UPIN