Provider Demographics
NPI:1962747360
Name:STOCKFISCH, ROBERT THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:STOCKFISCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:42 N PORT ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3927
Mailing Address - Country:US
Mailing Address - Phone:843-682-4032
Mailing Address - Fax:843-682-4032
Practice Address - Street 1:200 GULFSTREAM RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-9677
Practice Address - Country:US
Practice Address - Phone:912-965-6292
Practice Address - Fax:912-966-6367
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0520912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF73923Medicare UPIN
GA26BDJCBMedicare PIN