Provider Demographics
NPI:1821025008
Name:ENGUIDANOS, STEPHEN T (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:ENGUIDANOS
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 1:1110 JUNIPER AVENUE
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2218
Mailing Address - Country:US
Mailing Address - Phone:850-729-1444
Mailing Address - Fax:850-729-0300
Practice Address - Street 1:1110 JUNIPER AVENUE
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2218
Practice Address - Country:US
Practice Address - Phone:850-729-1444
Practice Address - Fax:850-729-0300
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266017200Medicaid
FLH43270Medicare UPIN
FL266017200Medicaid