Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | E-4250 | AR |
N | 208000000X | Pediatrician | E-4250 | AR |
N | 2080P0208X | Pediatric Infectious Diseases | E-4250 | AR |
Y | 2080P0208X | Pediatric Infectious Diseases | ME108825 | FL |
NPI | 1205926706 |
---|---|
Provider Name | Stephanie Stovall |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003194000 | (05) | FL |
155867001 | (05) | AR |
L23197 | (02) |