Provider Demographics
NPI:1750561486
Name:STIEGLITZ, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:STIEGLITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1305 S FORT HARRISON AVE
Mailing Address - Street 2:BLDG A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3301
Mailing Address - Country:US
Mailing Address - Phone:727-461-4600
Mailing Address - Fax:727-461-7330
Practice Address - Street 1:1305 S FORT HARRISON AVE
Practice Address - Street 2:BLDG A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3301
Practice Address - Country:US
Practice Address - Phone:727-461-4600
Practice Address - Fax:727-461-7330
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME33707207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62166Medicare PIN
FLE12161Medicare UPIN