Healthcare Provider Details

I. General information

NPI: 1518057454
Provider Name (Legal Business Name): BRIAN S STOVER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 5TH AVE W
HENDERSONVILLE NC
28739-4206
US

IV. Provider business mailing address

600 5TH AVE W
HENDERSONVILLE NC
28739-4206
US

V. Phone/Fax

Practice location:
  • Phone: 828-697-1343
  • Fax: 828-697-3224
Mailing address:
  • Phone: 828-697-1343
  • Fax: 828-697-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number551
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number551
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: