Provider Demographics
NPI:1942302799
Name:EUBANKS, STEPHEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:1720 DUNLAWTON AVE STE 2
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2916
Practice Address - Country:US
Practice Address - Phone:386-322-8310
Practice Address - Fax:386-322-8370
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23922207N00000X
FLME133377207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01239227Medicaid
CO070014537OtherRR MEDICARE
CO30757OtherBCBS
CO84-1511239OtherOTHER
CO070014537OtherRR MEDICARE
COC339718Medicare UPIN