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Individual

STEPAN OLIVA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
560 AVENUE K SE, WINTER HAVEN, FL 33880-4203
(863) 299-3376
Mailing address
560 AVENUE K SE, WINTER HAVEN, FL 33880-4203
(863) 299-3376

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME75639
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
43555
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
01
P00397643
RAILROAD MEDICARE
FL
Enumeration date
11/14/2006
Last updated
07/29/2009
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