Provider Demographics
NPI:1093915928
Name:STOVER, RACHEL S (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:S
Last Name:STOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:A100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:6290 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5831
Practice Address - Country:US
Practice Address - Phone:520-547-3900
Practice Address - Fax:520-547-3904
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2012-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ36813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139583OtherMEDICARE PTAN
AZ233796Medicaid