Provider Demographics
NPI:1841505492
Name:STANLEY D ROWICKI MD PA
Entity type:Organization
Organization Name:STANLEY D ROWICKI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-343-8982
Mailing Address - Street 1:4521 ATLANTIC BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-1137
Mailing Address - Country:US
Mailing Address - Phone:904-343-8982
Mailing Address - Fax:904-281-9806
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:904-343-8982
Practice Address - Fax:904-281-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000431700Medicaid