Healthcare Provider Details

I. General information

NPI: 1487751871
Provider Name (Legal Business Name): CURTIS CLARKE STINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 LEARNING WAY
TALLAHASSEE FL
32306-4178
US

IV. Provider business mailing address

1115 W CALL ST
TALLAHASSEE FL
32304-3556
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-6230
  • Fax: 850-644-4251
Mailing address:
  • Phone: 850-644-6230
  • Fax: 850-644-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME88595
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME88595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: