Provider Demographics
NPI:1588855639
Name:STAMAN, JONATHAN A (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:STAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8786 PERIMETER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6347
Mailing Address - Country:US
Mailing Address - Phone:904-997-9202
Mailing Address - Fax:904-996-1446
Practice Address - Street 1:8786 PERIMETER PARK BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6347
Practice Address - Country:US
Practice Address - Phone:904-997-9202
Practice Address - Fax:904-997-9205
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA68566207W00000X, 207WX0107X
FLME114146207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008870100Medicaid
GA003135004BMedicaid
FL008870100Medicaid
GA202I183443Medicare PIN