Individual
JAMES RUSSELL KELLER STACKHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6 S 14TH ST, FERNANDINA, FL 32034
(904) 261-5741
(904) 261-7383
Mailing address
6 S 14TH ST, FERNANDINA BEACH, FL 32034-3212
(904) 261-5741
(904) 261-7383
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
770778
GA
207W00000X
Ophthalmology Physician
Primary
ME117902
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100661200
—
FL
Enumeration date
06/04/2009
Last updated
09/29/2021
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