MEDICARE: PHILLIP EARL STOVER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25447	NC

General Provider Information

NPI Number	:	1770542318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP EARL STOVER MD

Provider Business Mailing Address
First Line	:	PO BOX 239
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-0239
Country	:	US
Telephone Number	:	919-496-1247
Fax Number	:	919-496-3307

Provider Business Practice Location Address
First Line	:	1501 N BICKETT BLVD
Second Line	:	SUITE G
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2178
Country	:	US
Telephone Number	:	919-496-1247
Fax Number	:	919-496-3307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	12/16/2009

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