Provider Demographics
NPI:1043278260
Name:STANKARD, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:STANKARD
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 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1613
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:1658 ST VINCENTS WAY
Practice Address - Street 2:#210
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8446
Practice Address - Country:US
Practice Address - Phone:904-214-8161
Practice Address - Fax:904-214-8164
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56957208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020039756OtherRAILROAD MEDICARE
205862OtherAVMED
5196465OtherAETNA
1705048OtherCIGNA
25097OtherBCBS FL
FL274937800Medicaid
1705048OtherCIGNA
205862OtherAVMED
FL25097YMedicare PIN