Longenecker, Stanton L

Longenecker, Stanton L is an individual health care provider with primary practice located at 2 Shircliff Way Ste 300 Credentialing Department, Jacksonville FL 32204-4753. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Longenecker, Stanton L can be contacted via phone (904) 204-5000.

Contact Information

Primary practice address
2 Shircliff Way Ste 300 Credentialing Department Jacksonville FL 32204-4753
Phone: (904) 204-5000
Fax: (904) 204-4000
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X ME49077 Florida
Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery 207XS0114X ME49077 Florida
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X ME49077 Florida

Profile Details

NPI number 1821092271
LBN Legal business name Longenecker, Stanton L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2005
Last updated Aug 1st, 2019 - 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 1821092271 NPPES
Florida MEDICAID 062862000

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