Provider Demographics
NPI:1902899826
Name:STOWERS, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:STOWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6867 SOUTHPOINT DRIVE NORTH
Mailing Address - Street 2:STE 111
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8005
Mailing Address - Country:US
Mailing Address - Phone:904-296-0278
Mailing Address - Fax:904-296-0279
Practice Address - Street 1:6867 SOUTHPOINT DRIVE NORTH
Practice Address - Street 2:STE 111
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8005
Practice Address - Country:US
Practice Address - Phone:904-296-0278
Practice Address - Fax:904-296-0279
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045359207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069358800Medicaid
FL110018797OtherMEDICARE RAILROAD
110018797OtherMEDICARE RAILROAD
FLFLD52765Medicare UPIN
FL110018797OtherMEDICARE RAILROAD
FL15867VMedicare ID - Type Unspecified