Individual
JOHN J STORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6716 NW 11TH PL, STE 200, GAINESVILLE, FL 32605-4215
(352) 331-9729
(352) 331-0136
Mailing address
6716 NW 11TH PL, STE 200, GAINESVILLE, FL 32605-4215
(352) 331-9729
(352) 331-0136
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME48078
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052302000
—
FL
01
—
10431
BCBSFL
FL
01
—
239216
AVMED
FL
01
—
270855
AVMED
FL
01
—
P000316736
RAIL ROAD MEDICARE
FL
01
—
P00323916
RAIL ROAD MEDICARE
FL
Enumeration date
05/06/2006
Last updated
03/10/2022
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