Healthcare Provider Details

I. General information

NPI: 1134115595
Provider Name (Legal Business Name): RICHARD B STOVALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 01/28/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BLDG 2 STE 201
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

PO BOX 25887
OKLAHOMA CITY OK
73125-0887
US

V. Phone/Fax

Practice location:
  • Phone: 512-835-8100
  • Fax: 512-835-8101
Mailing address:
  • Phone: 512-835-8100
  • Fax: 512-835-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberK5409
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: