Provider Demographics
NPI:1720049224
Name:STEIN, BERNARD D (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:D
Last Name:STEIN
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:PO BOX 18904
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-8904
Mailing Address - Country:US
Mailing Address - Phone:813-877-6511
Mailing Address - Fax:813-872-5695
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-877-6511
Practice Address - Fax:813-872-5695
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25485174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035101600Medicaid
IDD53780Medicare UPIN
FL29890YMedicare ID - Type Unspecified