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General NPI Number Information
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NPI Number | 1528562832
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Entity Type | Individual
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Provider Name | ANTHONY STEWART STACK II DO
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Gender | Male
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 1840 MEASE DR STE 409
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-6606
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Country | US
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Telephone | 727-443-8450
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Fax | 727-533-5911
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Provider Business Mailing Address
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Address Line | 2995 DREW ST FL 2
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City | CLEARWATER
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State | FL
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Zip | 33759-3012
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Country | US
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Telephone | 727-315-7496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | UO5932
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | UO5932
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License Number State | FL
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