Provider Demographics
NPI:1164550232
Name:STOER, CHARLES BLANCHARD (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BLANCHARD
Last Name:STOER
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 1:4525 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3901
Mailing Address - Country:US
Mailing Address - Phone:352-377-8619
Mailing Address - Fax:352-371-9674
Practice Address - Street 1:4525 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3901
Practice Address - Country:US
Practice Address - Phone:352-377-8619
Practice Address - Fax:352-371-9674
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044326207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040704600Medicaid
P00678454OtherRAILROAD MEDICARE
020005584OtherRAILROAD MEDICARE
FL040704600Medicaid
P00678454OtherRAILROAD MEDICARE
FL68362OtherBCBS OF FL