Provider Demographics
NPI:1619902707
Name:STEM, JESSE L (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:L
Last Name:STEM
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 1:7800 66TH ST N STE 105
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2101
Mailing Address - Country:US
Mailing Address - Phone:727-490-9115
Mailing Address - Fax:855-592-2984
Practice Address - Street 1:7800 66TH ST N STE 105
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2101
Practice Address - Country:US
Practice Address - Phone:727-490-9115
Practice Address - Fax:855-592-2984
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230890207X00000X, 207XS0117X
FLME161780207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010160952Medicaid
FL123697700Medicaid
VAP00220195OtherMEDICARE RAILROAD PIN
VA1619902707Medicaid
P01584711Medicare PIN
VAP00220195OtherMEDICARE RAILROAD PIN
VA1619902707Medicaid