Healthcare Provider Details

I. General information

NPI: 1881664480
Provider Name (Legal Business Name): ALTON L. STOCKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 817 BOX 2461
FPO AE
09622
IT

IV. Provider business mailing address

PSC 817 BOX 2461
FPO AE
09622
IT

V. Phone/Fax

Practice location:
  • Phone: 011390815684519
  • Fax:
Mailing address:
  • Phone: 011390815684519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101042159
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: