Healthcare Provider Details

I. General information

NPI: 1710622329
Provider Name (Legal Business Name): EVA GRAY STOOPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 QUEENSWAY E UNIT 6 AND 7
MISSISSAUGA ONTARIO
L4Y4C5
CA

IV. Provider business mailing address

PO BOX 95108
PALATINE IL
60095-0108
US

V. Phone/Fax

Practice location:
  • Phone: 905-896-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.080222
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: