Provider Demographics
NPI:1790727253
Name:EIDELSON, STEWART G (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:G
Last Name:EIDELSON
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 1:15300 JOG RD
Mailing Address - Street 2:SUITE 107-108
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2164
Mailing Address - Country:US
Mailing Address - Phone:561-742-5959
Mailing Address - Fax:561-734-2226
Practice Address - Street 1:15300 JOG RD
Practice Address - Street 2:SUITE 107-108
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2164
Practice Address - Country:US
Practice Address - Phone:561-742-5959
Practice Address - Fax:561-734-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055593207X00000X
CAG89325207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPTAN HH411ZMedicare PIN
FLC74683Medicare UPIN
FLPTAN AD477Medicare PIN