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NPI Code Detail

MEDICARE: RANDALL DEAN STOCKSTILL M.D.

MEDICARE: RANDALL DEAN STOCKSTILL 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
1207L00000XAnesthesiology PhysicianE4704TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28U7781OTHERTXBCBSTX
30062PAOTHERTXBCBS IND # PAIN
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265421804
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDALL DEAN STOCKSTILL M.D.
Provider Business Mailing Address
First Line : PO BOX 7301
Second Line :
City : ABILENE
State : TX
Zip : 79608-7301
Country : US
Telephone Number : 325-793-5380
Fax Number : 325-793-5259
Provider Business Practice Location Address
First Line : 6250 US HWY 83/84
Second Line :
City : ABILENE
State : TX
Zip : 79606-5215
Country : US
Telephone Number : 325-793-5380
Fax Number : 325-202-3060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 07/21/2008

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