Individual
MR. SHANE THOMAS STOCKELMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
3334 CAPITAL MEDICAL BLVD, TALLAHASSEE, FL 32308-8405
(850) 877-8174
Mailing address
1420 N MERIDIAN RD APT 128, TALLAHASSEE, FL 32303-5658
(954) 650-0333
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
5752
FL
Other
Enumeration date
02/11/2020
Last updated
02/11/2020
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