1285181826 NPI number — MR. STEVEN D DITTERT RPH

Table of content: MR. STEVEN D DITTERT RPH (NPI 1285181826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285181826 NPI number — MR. STEVEN D DITTERT RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DITTERT
Provider First Name:
STEVEN
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285181826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 294
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE PANASOFFKEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33538-0294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-513-5937
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
846 NE 54TH TERRACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLEMAN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-689-5212
Provider Business Practice Location Address Fax Number:
352-689-5293
Provider Enumeration Date:
09/01/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  28808 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 8431 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 21462 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)