Provider Demographics
NPI:1376618470
Name:DENNISON, STANLEY ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ROBERT
Last Name:DENNISON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1921 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6509
Mailing Address - Country:US
Mailing Address - Phone:813-876-7600
Mailing Address - Fax:813-876-7675
Practice Address - Street 1:1921 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6509
Practice Address - Country:US
Practice Address - Phone:813-876-7600
Practice Address - Fax:813-876-7675
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069243208VP0014X, 207LP2900X
FLME692432086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68784BMedicare ID - Type Unspecified
G26777Medicare UPIN