Healthcare Provider Details

I. General information

NPI: 1902899826
Provider Name (Legal Business Name): STEPHEN STOWERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 SOUTHPOINT DRIVE NORTH STE 111
JACKSONVILLE FL
32216-8005
US

IV. Provider business mailing address

6867 SOUTHPOINT DRIVE NORTH STE 111
JACKSONVILLE FL
32216-8005
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-0278
  • Fax: 904-296-0279
Mailing address:
  • Phone: 904-296-0278
  • Fax: 904-296-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0045359
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME0045359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: