Provider Demographics
NPI:1972547370
Name:STABLER, JOHN BRENT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BRENT
Last Name:STABLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5051 SE 110TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3115
Mailing Address - Country:US
Mailing Address - Phone:352-674-1730
Mailing Address - Fax:352-674-8930
Practice Address - Street 1:8877 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5887
Practice Address - Country:US
Practice Address - Phone:352-674-1750
Practice Address - Fax:523-674-8950
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME106358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009991535Medicaid
G65735Medicare UPIN
AL051527912STAMedicare ID - Type Unspecified