Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME44104 | FL |
NPI | 1033116975 |
---|---|
Provider Name | Dr. Gregory J. Stella |
First Address | Jacksonville, FL 32256-6004 |
Second Address | Port Orange, FL 32129-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 03/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270347500 | (05) | FL |