Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME0062874 | FL |
NPI | 1508865924 |
---|---|
Provider Name | Dr. Brett E Stanaland |
First Address | Naples, FL 34102-5474 |
Second Address | Naples, FL 34102-5474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 25/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26815 | BLUE CROSS PROVIDER # (01) | |
378659500 | (05) | FL |
E54486 | (02) | FL |