Healthcare Provider Details

I. General information

NPI: 1710174602
Provider Name (Legal Business Name): BRETT E. STANALAND, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GOODLETTE RD N SUITE 200
NAPLES FL
34102-5474
US

IV. Provider business mailing address

1000 GOODLETTE RD N SUITE 200
NAPLES FL
34102-5474
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-6200
  • Fax: 239-434-5741
Mailing address:
  • Phone: 239-434-6200
  • Fax: 239-434-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME0062874
License Number StateFL

VIII. Authorized Official

Name: DR. BRETT E STANALAND
Title or Position: PRESIDENT
Credential: MD
Phone: 239-434-6200