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General NPI Number Information
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NPI Number | 1669579124
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Entity Type | Individual
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Provider Name | ANTHONY J STOCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12231 ASHLEY DRIVE SUITE C
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City | GULFPORT
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State | MS
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Zip | 39503-2775
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Country | US
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Telephone | 228-831-9400
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Fax | 228-831-9600
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Provider Business Mailing Address
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Address Line | 12231 ASHLEY DRIVE SUITE C
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City | GULFPORT
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State | MS
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Zip | 39503-2775
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Country | US
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Telephone | 228-831-9400
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Fax | 228-831-9600
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MS13805
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License Number State | MS
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