Provider Demographics
NPI:1891734067
Name:GUSS, STEPHEN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:GUSS
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 1:1223 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2607
Mailing Address - Country:US
Mailing Address - Phone:321-725-4500
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1421 MALABAR RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2576
Practice Address - Country:US
Practice Address - Phone:321-434-8080
Practice Address - Fax:321-434-8137
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042515208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN370020659OtherMEDICARE RAILROAD
IN100389510AMedicaid
IN187780BMedicare PIN
IN227950D1Medicare PIN
IN370020659OtherMEDICARE RAILROAD
INE89700Medicare UPIN
IN187730GMedicare PIN