MEDICARE: DR. PHILLIP ROGER STOVER 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	208000000X	Pediatrics Physician	13892	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1962453852	OTHER	AL	NPI
2	51591327	OTHER	AL	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962453852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP ROGER STOVER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 415
Second Line	:
City	:	MC INTOSH
State	:	AL
Zip	:	36553-0415
Country	:	US
Telephone Number	:	251-944-2842
Fax Number	:	251-944-8070

Provider Business Practice Location Address
First Line	:	7777 HIGHWAY 43 NORTH
Second Line	:
City	:	MCINTOSH
State	:	AL
Zip	:	36553
Country	:	US
Telephone Number	:	251-944-2842
Fax Number	:	251-944-8070

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	03/03/2010

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Directions to “ DR. PHILLIP ROGER STOVER M.D.” Practice Location

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