Healthcare Provider Details

I. General information

NPI: 1881967982
Provider Name (Legal Business Name): DAVID WAYNE STOVALL DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28400 OLD 41 RD SUITE 1
BONITA SPRINGS FL
34135-6812
US

IV. Provider business mailing address

28400 OLD 41 RD SUITE 1
BONITA SPRINGS FL
34135-6812
US

V. Phone/Fax

Practice location:
  • Phone: 239-992-8387
  • Fax:
Mailing address:
  • Phone: 239-992-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number11381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: