Provider Demographics
NPI:1063809754
Name:STERN, HARLAN B (B)
Entity type:Individual
Prefix:
First Name:HARLAN
Middle Name:B
Last Name:STERN
Suffix:
Gender:M
Credentials:B
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9430
Mailing Address - Fax:239-343-9495
Practice Address - Street 1:8960 COLONIAL CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7803
Practice Address - Country:US
Practice Address - Phone:239-343-9430
Practice Address - Fax:239-343-9495
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL148910208VP0014X
FLME148910207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115197000Medicaid