# JESSE L STEM MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revelation Spine Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720842503
- **Authorized official:** JESSE L STEM MD (OWNER)
- **Authorized official phone:** (727) 490-9115

## Contact information

- **Practice address:** 7800 66TH ST N STE 105, PINELLAS PARK, FL 33781-2101
- **Practice address phone:** (727) 490-9115
- **Practice address fax:** (855) 592-2984
- **Mailing address:** 7800 66TH ST N STE 105, PINELLAS PARK, FL 33781-2101
- **Mailing address phone:** (540) 525-9759
- **Mailing address fax:** (855) 592-2984

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | NULL | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | — | — |

## Other

- **Enumeration date:** 02/12/2024
- **Last updated:** 04/24/2025