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General NPI Number Information
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NPI Number | 1134115595
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Entity Type | Individual
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Provider Name | RICHARD B STOVALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 2200 PARK BEND DR BLDG 2 STE 201
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City | AUSTIN
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State | TX
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Zip | 78758-5387
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Country | US
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Telephone | 512-835-8100
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Fax | 512-835-8101
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Provider Business Mailing Address
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Address Line | PO BOX 25887
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City | OKLAHOMA CITY
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State | OK
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Zip | 73125-0887
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Country | US
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Telephone | 512-835-8100
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Fax | 512-835-8101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | K5409
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License Number State | TX
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