Healthcare Provider Details

I. General information

NPI: 1164550232
Provider Name (Legal Business Name): CHARLES BLANCHARD STOER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 SW 13TH ST
GAINESVILLE FL
32608-3901
US

IV. Provider business mailing address

4525 SW 13TH ST
GAINESVILLE FL
32608-3901
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-8619
  • Fax: 352-371-9674
Mailing address:
  • Phone: 352-377-8619
  • Fax: 352-371-9674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0044326
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME0044326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: