Provider Demographics
NPI:1427084649
Name:STIGLITZ, AVERY (MD)
Entity type:Individual
Prefix:DR
First Name:AVERY
Middle Name:
Last Name:STIGLITZ
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 1:3131 N MCMULLEN BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2008
Mailing Address - Country:US
Mailing Address - Phone:727-726-8871
Mailing Address - Fax:727-799-8605
Practice Address - Street 1:3131 N MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2008
Practice Address - Country:US
Practice Address - Phone:727-726-8871
Practice Address - Fax:727-799-8605
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21397208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D55958Medicare UPIN
FL51083YMedicare PIN