Healthcare Provider Details

I. General information

NPI: 1679671911
Provider Name (Legal Business Name): DAVID BRUCE STOECKLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 DAVIS ST STE 1
BLACKSBURG VA
24060-7004
US

IV. Provider business mailing address

817 DAVIS ST STE 1
BLACKSBURG VA
24060-7004
US

V. Phone/Fax

Practice location:
  • Phone: 540-552-3670
  • Fax: 540-951-2215
Mailing address:
  • Phone: 540-552-3670
  • Fax: 540-552-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101029405
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: