Provider Demographics
NPI:1821105479
Name:STALNAKER, BENJAMIN LOUIE JR (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LOUIE
Last Name:STALNAKER
Suffix:JR
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 1:5551 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459
Mailing Address - Country:US
Mailing Address - Phone:850-420-5420
Mailing Address - Fax:850-244-8011
Practice Address - Street 1:5551 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459
Practice Address - Country:US
Practice Address - Phone:850-420-5420
Practice Address - Fax:850-244-8011
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME10375174400000X, 207P00000X
ALMD.2888207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17185OtherBCBS-FL
FL017811800Medicaid
FL17185Medicare ID - Type Unspecified