Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 042952 | GA |
N | 207Q00000X | Family Doctor | ME56958 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | ME56958 | FL |
NPI | 1043213879 |
---|---|
Provider Name | Kris D Stowers |
First Address | Tallahassee, FL 32308-4470 |
Second Address | Tallahassee, FL 32308-4470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 24/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000488958C | (05) | GA |
062509400 | (05) | FL |
B48059 | (02) | FL |