Individual
STACY L HARBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3871 E HIGHWAY 98 STE 200, PORT ST JOE, FL 32456-5302
(850) 229-5833
Mailing address
4205 BELFORT RD STE 4015, JACKSONVILLE, FL 32216-3623
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
31761
KY
208600000X
Surgery Physician
Primary
ME108578
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000329454
BCBS PROVIDER NUMBER
—
01
—
31761
LICENSE
KY
05
—
64317613
—
KY
01
—
ME108578
FLORDIA MEDICAL LICENSE
—
Enumeration date
09/16/2006
Last updated
07/27/2021
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