Healthcare Provider Details

I. General information

NPI: 1972547370
Provider Name (Legal Business Name): JOHN BRENT STABLER FAMILY MEDICINE, BOA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SE WENONA AVE
OCALA FL
34471-2222
US

IV. Provider business mailing address

19 SE WENONA AVE
OCALA FL
34471-2222
US

V. Phone/Fax

Practice location:
  • Phone: 866-492-3627
  • Fax: 888-613-7273
Mailing address:
  • Phone: 866-492-3627
  • Fax: 888-613-7273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME106358
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: