Basic Information
Provider Information
NPI: 1164460960
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PHLAUM
FirstName: STEPHEN
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2699
Address2:  
City: PENSACOLA
State: FL
PostalCode: 325132699
CountryCode: US
TelephoneNumber: 8504754500
FaxNumber: 8504754619
Practice Location
Address1: 7720 US HIGHWAY 98 W
Address2: 350
City: DESTIN
State: FL
PostalCode: 325507230
CountryCode: US
TelephoneNumber: 8502671603
FaxNumber: 8502671862
Other Information
ProviderEnumerationDate: 06/03/2006
LastUpdateDate: 03/17/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XME94592FLY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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