Healthcare Provider Details

I. General information

NPI: 1730589458
Provider Name (Legal Business Name): DRS MOORE & STOCKSTILL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 BERNARD DR SUITE 301
ROANOKE VA
24018-4349
US

IV. Provider business mailing address

5115 BERNARD DR SUITE 301
ROANOKE VA
24018-4357
US

V. Phone/Fax

Practice location:
  • Phone: 540-904-7710
  • Fax:
Mailing address:
  • Phone: 540-345-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number101045664
License Number StateVA

VIII. Authorized Official

Name: DR. KURT ROBERT STOCKSTILL
Title or Position: PRESIDENT
Credential: MD
Phone: 540-345-3556