Healthcare Provider Details

I. General information

NPI: 1215374251
Provider Name (Legal Business Name): HUGH TOLAND STODDARD III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 MEMORIAL HWY
TAMPA FL
33615-4531
US

IV. Provider business mailing address

6001 MEMORIAL HWY
TAMPA FL
33615-4531
US

V. Phone/Fax

Practice location:
  • Phone: 813-882-4206
  • Fax:
Mailing address:
  • Phone: 813-882-4206
  • Fax: 813-886-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number192167
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number66519
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: