Provider Demographics
NPI:1437325875
Name:CHARLES BLANCHARD STOER MD PA
Entity Type:Organization
Organization Name:CHARLES BLANCHARD STOER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BLANCHARD
Authorized Official - Last Name:STOER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-377-8619
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X, 207ND0101X
FLPA9103783363A00000X
FLARNP1942732363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDO4107OtherRAILROAD MEDICARE
FL003FQOtherFLORIDA BLUE
FL9642865OtherAETNA
FLK9033AMedicare PIN