Individual
DR. CHARLES A STANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 13TH STREET, GULFPORT, MS 39501
(228) 867-4396
(228) 867-5354
Mailing address
PO BOX 1810, GULFPORT, MS 39502
(228) 575-1194
(228) 575-2917
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19513
MS
208M00000X
Hospitalist Physician
19513
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
646000515E
BLUE CROSS OF MS
MS
Enumeration date
10/23/2006
Last updated
09/28/2023
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