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General NPI Number Information
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NPI Number | 1053626945
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Entity Type | Organization
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Legal Business Name | J DEAN STOCKSTILL MD, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 3510 MAGNOLIA CV SUITE 190
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City | MONROE
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State | LA
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Zip | 71203-2372
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Country | US
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Telephone | 318-323-7576
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Fax | 318-322-7131
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Provider Business Mailing Address
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Address Line | 3510 MAGNOLIA CV SUITE 190
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City | MONROE
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State | LA
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Zip | 71203-2372
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Country | US
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Telephone | 318-323-7576
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Fax | 318-322-7131
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES DEAN STOCKSTILL
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Credential | MD
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Telephone | 317-323-7576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L06937R
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License Number State | LA
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