Provider Demographics
NPI:1396715801
Name:MERITT, STEPHEN MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:MERITT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-4332
Mailing Address - Country:US
Mailing Address - Phone:904-355-1553
Mailing Address - Fax:904-356-7774
Practice Address - Street 1:431 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4332
Practice Address - Country:US
Practice Address - Phone:904-355-1553
Practice Address - Fax:904-356-7774
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO865213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL MCAIDMedicaid
GA000824854CMedicaid
FL480027244OtherRAILROAD MEDICARE
FLU08605Medicare UPIN
FL87331YMedicare PIN
GA000824854CMedicaid