Provider Demographics
NPI:1891234936
Name:STOCKETT, LES KEITH (TELEMED HEALTH GROUP)
Entity Type:Individual
Prefix:MR
First Name:LES
Middle Name:KEITH
Last Name:STOCKETT
Suffix:
Gender:M
Credentials:TELEMED HEALTH GROUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 THE GREEN
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901
Mailing Address - Country:US
Mailing Address - Phone:561-922-3953
Mailing Address - Fax:561-300-6544
Practice Address - Street 1:8 THE GRN
Practice Address - Street 2:SUITE A
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3618
Practice Address - Country:US
Practice Address - Phone:561-922-3953
Practice Address - Fax:561-300-6544
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE6056115251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage