MEDICARE: RICHARD B STOVALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	K5409	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8S5890	OTHER	TX	BC/BS INDIVIDUAL

General Provider Information

NPI Number	:	1134115595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD B STOVALL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 25887
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73125-0887
Country	:	US
Telephone Number	:	512-835-8100
Fax Number	:	512-835-8101

Provider Business Practice Location Address
First Line	:	2200 PARK BEND DR
Second Line	:	BLDG 2 STE 201
City	:	AUSTIN
State	:	TX
Zip	:	78758-5387
Country	:	US
Telephone Number	:	512-835-8100
Fax Number	:	512-835-8101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	01/28/2022

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