Healthcare Provider Details

I. General information

NPI: 1063467124
Provider Name (Legal Business Name): STEPHEN PETER STOWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 EAST CENTER ST SUITE A
MOORESVILLE NC
28115-2590
US

IV. Provider business mailing address

PO BOX 1350
MOORESVILLE NC
28115-1350
US

V. Phone/Fax

Practice location:
  • Phone: 704-663-5090
  • Fax: 704-663-5502
Mailing address:
  • Phone: 704-799-3380
  • Fax: 704-799-6315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35525
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: