Healthcare Provider Details

I. General information

NPI: 1043213879
Provider Name (Legal Business Name): KRIS D STOWERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 CAPITAL MEDICAL BLVD STE 400
TALLAHASSEE FL
32308-4470
US

IV. Provider business mailing address

3334 CAPITAL MEDICAL BLVD STE 400
TALLAHASSEE FL
32308-4470
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-8174
  • Fax: 442-616-8398
Mailing address:
  • Phone: 850-877-8174
  • Fax: 850-877-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME56958
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME56958
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: