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NPI Code Detail

MEDICARE: JOHN WILLIAM STOVER MD

MEDICARE: JOHN WILLIAM STOVER MD
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
1207P00000XEmergency Medicine PhysicianMD2005-0155NM

General Provider Information

NPI Number : 1689661647
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN WILLIAM STOVER MD
Provider Business Mailing Address
First Line : 6908 OERSTED RD NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-6573
Country : US
Telephone Number : 505-205-1273
Fax Number :
Provider Business Practice Location Address
First Line : 6908 OERSTED RD NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-6573
Country : US
Telephone Number : 505-205-1273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 06/12/2009

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