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Organization
PROMISE MEDICAL GROUP, PLLC
Active
Organization
PROMISE MEDICAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID WAYNE STEPHENSON MD (PRESIDENT)
(352) 812-0579
Entity
Organization
Contact information
Practice address
9202 NW 26TH ST, WILDWOOD, FL 34785-7413
(352) 812-0579
(352) 571-4349
Mailing address
9202 NW 26TH ST, WILDWOOD, FL 34785-7413
(352) 812-0579
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME106525
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FD876Z
MEDICARE
FL
Enumeration date
09/19/2012
Last updated
07/29/2024
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