Provider Demographics
NPI:1063494748
Name:STOCKSTILL, JAMES DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEAN
Last Name:STOCKSTILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 MAGNOLIA CV
Mailing Address - Street 2:SUITE 190
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2372
Mailing Address - Country:US
Mailing Address - Phone:318-323-7576
Mailing Address - Fax:318-322-7131
Practice Address - Street 1:3510 MAGNOLIA CV
Practice Address - Street 2:SUITE 190
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2372
Practice Address - Country:US
Practice Address - Phone:318-323-7576
Practice Address - Fax:318-322-7131
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL06937R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B62747Medicare UPIN
51002Medicare ID - Type Unspecified