Healthcare Provider Details

I. General information

NPI: 1467420711
Provider Name (Legal Business Name): DONALD E STOWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 N CALIFORNIA ST STE 1D
STOCKTON CA
95204
US

IV. Provider business mailing address

1617 N CALIFORNIA ST STE 1D
STOCKTON CA
95204-6117
US

V. Phone/Fax

Practice location:
  • Phone: 209-948-1234
  • Fax:
Mailing address:
  • Phone: 209-579-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21190
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number21190
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number21190
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number21190
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: