Provider Demographics
NPI:1578551842
Name:STANLEY F. STOCKHAMMER, JR. D.O., P.A.
Entity Type:Organization
Organization Name:STANLEY F. STOCKHAMMER, JR. D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:STOCKHAMMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:386-299-4543
Mailing Address - Street 1:30 WINDING CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6773
Mailing Address - Country:US
Mailing Address - Phone:386-299-4543
Mailing Address - Fax:386-673-3324
Practice Address - Street 1:2370 E INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-2744
Practice Address - Country:US
Practice Address - Phone:386-736-1105
Practice Address - Fax:386-734-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257429200Medicaid
FL98812AMedicare ID - Type UnspecifiedGROUP