Provider Demographics
NPI:1255007506
Name:RUEL T STOESSEL MD PA
Entity Type:Organization
Organization Name:RUEL T STOESSEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUEL
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:STOESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-630-8001
Mailing Address - Street 1:8645 N MILITARY TRL STE 508
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6296
Mailing Address - Country:US
Mailing Address - Phone:561-630-8001
Mailing Address - Fax:
Practice Address - Street 1:1700 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4803
Practice Address - Country:US
Practice Address - Phone:772-461-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUEL T STOESSEL MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty