Provider Demographics
NPI:1962515155
Name:SNOW, STEPHEN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PATRICK
Last Name:SNOW
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:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:1116 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1017
Practice Address - Country:US
Practice Address - Phone:407-316-8550
Practice Address - Fax:407-316-8311
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51998207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272025600Medicaid
FL047943800Medicaid
FLO1285ZOtherMEDICARE NO SPECIFIC
FLCG4039Medicare PIN
FL047943800Medicaid
FL21238Medicare PIN
FLD51384Medicare UPIN
FLD37727Medicare PIN
FL05663XMedicare ID - Type Unspecified