Individual
STEPHEN LOBASKY WANNAH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9981 S HEALTHPARK DR, FORT MYERS, FL 33908-3618
(239) 343-2052
(239) 343-5348
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-2052
(239) 343-5348
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME166398
FL
207Q00000X
Family Medicine Physician
MT224247
PA
208M00000X
Hospitalist Physician
Primary
ME166398
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121949300
—
FL
Enumeration date
07/01/2021
Last updated
11/18/2024
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