Individual
STEPHEN LACKEY CHASTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5850 SE COMMUNITY DR, STUART, FL 34997-6420
(772) 324-3500
Mailing address
9611 N US HIGHWAY 1, #166, SEBASTIAN, FL 32958-6363
(772) 581-3990
(772) 581-3991
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
00014657
AL
207R00000X
Internal Medicine Physician
33627
SC
207R00000X
Internal Medicine Physician
ME114042
FL
207RC0000X
Cardiovascular Disease Physician
Primary
ME114042
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00083765
—
AL
05
—
336274
—
SC
01
—
51083765
BLUE CROSS BLUE SHIELD
AL
Enumeration date
03/18/2006
Last updated
05/09/2013
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