Healthcare Provider Details

I. General information

NPI: 1366837353
Provider Name (Legal Business Name): WESTON SCOTT STOVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 W RAY RD STE 3
CHANDLER AZ
85224-3549
US

IV. Provider business mailing address

PO BOX 20610
MESA AZ
85277-0610
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-4709
  • Fax: 480-296-7665
Mailing address:
  • Phone: 480-985-1093
  • Fax: 480-296-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number78281
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberS6063
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: