Provider Demographics
NPI:1922161561
Name:CRUM, STEPHANIE PAIGE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:PAIGE
Last Name:CRUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10000 W COLONIAL DR
Mailing Address - Street 2:SUITE 390
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3400
Mailing Address - Country:US
Mailing Address - Phone:407-290-2394
Mailing Address - Fax:407-521-3640
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:SUITE 390
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3400
Practice Address - Country:US
Practice Address - Phone:407-290-2394
Practice Address - Fax:407-521-3640
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME73314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics