Healthcare Provider Details

I. General information

NPI: 1154070217
Provider Name (Legal Business Name): CONNOR STONESIFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 ARCOS AVE STE 201
ESTERO FL
33928-3529
US

IV. Provider business mailing address

10200 ARCOS AVE STE 201
ESTERO FL
33928-3529
US

V. Phone/Fax

Practice location:
  • Phone: 239-390-3376
  • Fax:
Mailing address:
  • Phone: 239-390-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME181314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: