Individual
STANTON L LONGENECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 SHIRCLIFF WAY STE 300, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32204-4753
(904) 204-5000
(904) 204-4000
Mailing address
11945 SAN JOSE BLVD STE 300, JACKSONVILLE, FL 32223-1627
(904) 396-1725
(904) 396-4893
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
ME49077
FL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
ME49077
FL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
ME49077
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062862000
—
FL
Enumeration date
06/13/2005
Last updated
08/01/2019
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