Provider Demographics
NPI:1821092701
Name:FAYNE, STEVEN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DAVID
Last Name:FAYNE
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 1:8890 W OAKLAND PARK BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7223
Mailing Address - Country:US
Mailing Address - Phone:954-741-3305
Mailing Address - Fax:954-741-3306
Practice Address - Street 1:8890 W OAKLAND PARK BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7223
Practice Address - Country:US
Practice Address - Phone:954-741-3305
Practice Address - Fax:954-741-3306
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42650207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94536Medicare ID - Type Unspecified
FLD63261Medicare UPIN