Stackhouse, James Russell Keller

Stackhouse, James Russell Keller is an individual health care provider with primary practice located at 6 S 14Th St , Fernandina FL 32034. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Stackhouse, James Russell Keller can be contacted via phone (904) 261-5741.

Contact Information

Primary practice address
6 S 14Th St Fernandina FL 32034
Phone: (904) 261-5741
Fax: (904) 261-7383
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 770778 Georgia
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X ME117902 Florida

Profile Details

NPI number 1750517710
LBN Legal business name Stackhouse, James Russell Keller
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 4th, 2009
Last updated Sep 29th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750517710 NPPES
Florida MEDICAID 100661200

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