Provider Demographics
NPI:1811960958
Name:STOCKAMP, KURT T (MD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:T
Last Name:STOCKAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4205 BELFORT RD
Mailing Address - Street 2:STE 4015
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6014
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:STE. 203
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8771
Practice Address - Country:US
Practice Address - Phone:850-476-6110
Practice Address - Fax:850-479-6042
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME64368208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18969OtherBCBS
FL372995800OtherMEDICAID
AL009935384OtherAL MEDICAID
AL59101757OtherBCBS
AL59101757OtherBCBS
FL372995800OtherMEDICAID