Provider Demographics
NPI:1063412781
Name:FLETCHER, STEVEN MARK (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:FLETCHER
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 1:925 NE 30TH TER
Mailing Address - Street 2:# 214
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7613
Mailing Address - Country:US
Mailing Address - Phone:305-245-5881
Mailing Address - Fax:786-533-1680
Practice Address - Street 1:925 NE 30TH TER
Practice Address - Street 2:# 214
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7613
Practice Address - Country:US
Practice Address - Phone:305-245-5881
Practice Address - Fax:786-533-1680
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46707207YP0228X, 207YS0123X, 207YX0007X, 207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048348600Medicaid
FLD61270Medicare UPIN
FL048348600Medicaid