Provider Demographics
NPI:1609877067
Name:STOCKEL, JOHN BRENNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRENNAN
Last Name:STOCKEL
Suffix:
Gender:M
Credentials:MD
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 7623
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-7623
Mailing Address - Country:US
Mailing Address - Phone:305-712-7229
Mailing Address - Fax:305-397-1139
Practice Address - Street 1:3663 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4253
Practice Address - Country:US
Practice Address - Phone:305-854-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2210932085N0700X
VA01012290142085N0700X
FLME830532085N0700X, 2085R0202X
CO421512085N0700X
CAAFE453102085N0700X
DEC100058852085N0700X
TXM76562085N0700X
PAMD072116L2085N0700X
OH35077791S2085N0700X
MDD00455412085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP02028187OtherFLORIDA RAILROAD MEDICARE
FL10434355OtherCAQH
FLHR328XOtherFLORIDA MEDICARE
FL96JV5OtherFLORIDA BLUE (BCBS)
FL101407400Medicaid
PA19601290001Medicaid
WV120952000Medicaid
MD192MD225Medicare PIN
DE009238M06Medicare PIN
OH4023373Medicare PIN
OH4023374Medicare PIN
PA056661N7WMedicare PIN