Provider Demographics
NPI:1275571135
Name:STALNAKER, TODD DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DANIEL
Last Name:STALNAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-2550
Mailing Address - Fax:850-416-2539
Practice Address - Street 1:5153 N 9TH AVE
Practice Address - Street 2:205
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-416-2550
Practice Address - Fax:850-416-2539
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6213207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056787600Medicaid
FL80570Medicare ID - Type Unspecified
FL056787600Medicaid