Provider Demographics
NPI:1679538425
Name:STERN, MARK SAM (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:SAM
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5210 INTERBAY BLVD
Mailing Address - Street 2:APT 9
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-4145
Mailing Address - Country:US
Mailing Address - Phone:813-334-2795
Mailing Address - Fax:813-287-0671
Practice Address - Street 1:5210 INTERBAY BLVD
Practice Address - Street 2:APT 9
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-4145
Practice Address - Country:US
Practice Address - Phone:813-334-2795
Practice Address - Fax:813-287-0671
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2016-06-15
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Provider Licenses
StateLicense IDTaxonomies
FLME 33074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
79422XMedicare PIN
FLD82653Medicare UPIN