Healthcare Provider Details

I. General information

NPI: 1811960958
Provider Name (Legal Business Name): KURT T STOCKAMP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 N 9TH AVE STE. 203
PENSACOLA FL
32504-8771
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-6110
  • Fax: 850-479-6042
Mailing address:
  • Phone: 904-450-6014
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME64368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: