Healthcare Provider Details

I. General information

NPI: 1164869715
Provider Name (Legal Business Name): BRIAN DAVID STOVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD BOX 100296
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100296
GAINESVILLE FL
32610-0296
US

V. Phone/Fax

Practice location:
  • Phone: 832-326-2361
  • Fax:
Mailing address:
  • Phone: 352-273-9120
  • Fax: 352-273-5941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME137993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: