Provider Demographics
NPI:1720304454
Name:DEMETER, STEPHEN L (PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:DEMETER
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 SANIBEL LN
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2585
Mailing Address - Country:US
Mailing Address - Phone:850-501-6046
Mailing Address - Fax:
Practice Address - Street 1:8360 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-2025
Practice Address - Country:US
Practice Address - Phone:334-255-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0800782146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic