Provider Demographics
NPI:1881658987
Name:STEIN, DOUGLAS GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GEORGE
Last Name:STEIN
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 1:3000 E FLETCHER AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4656
Mailing Address - Country:US
Mailing Address - Phone:813-972-1365
Mailing Address - Fax:813-971-9529
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-972-1365
Practice Address - Fax:813-971-9529
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35640174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258558800Medicaid
FL258558800Medicaid
25036ZMedicare PIN