Individual
MARK STAMOWLAROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4901 GRANDE DR, PENSACOLA, FL 32504-5935
(850) 477-7042
(850) 474-9060
Mailing address
4901 GRANDE DR, PENSACOLA, FL 32504-5935
(850) 477-7042
(850) 474-9060
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R045868
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104829
—
AL
05
—
242130099
—
ME
05
—
307975900
—
FL
01
—
592-03334
BLUE CROSS BLUE SHIELD
AL
01
—
G4098
BLUE CROSS BLUE SHIELD
FL
01
—
P00151925
RAILROAD MEDICARE
—
Enumeration date
08/16/2006
Last updated
06/16/2009
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