Provider Demographics
NPI:1669579124
Name:STOCK, ANTHONY J (MD)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:STOCK
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 1:12231 ASHLEY DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2775
Mailing Address - Country:US
Mailing Address - Phone:228-831-9400
Mailing Address - Fax:228-831-9600
Practice Address - Street 1:12231 ASHLEY DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2775
Practice Address - Country:US
Practice Address - Phone:228-831-9400
Practice Address - Fax:228-831-9600
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS13805174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSF21280Medicare UPIN