Provider Demographics
NPI:1366776379
Name:DIMSE, STEVEN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SCOTT
Last Name:DIMSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 LE GRAND LN
Mailing Address - Street 2:
Mailing Address - City:CUDJOE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-4230
Mailing Address - Country:US
Mailing Address - Phone:305-942-1174
Mailing Address - Fax:
Practice Address - Street 1:189 LE GRAND LN
Practice Address - Street 2:
Practice Address - City:CUDJOE KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-4230
Practice Address - Country:US
Practice Address - Phone:305-942-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-51185207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51053Medicare UPIN