Provider Demographics
NPI:1104034164
Name:STANCOVEN, KEVIN M (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:STANCOVEN
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Gender:M
Credentials:DO
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Mailing Address - Street 1:P.O. BOX 2386
Mailing Address - Street 2:BRAZOS VALLEY PATHOLOGY
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664
Mailing Address - Country:US
Mailing Address - Phone:972-489-0201
Mailing Address - Fax:512-597-2713
Practice Address - Street 1:201 SETON PARKWAY
Practice Address - Street 2:SETON MEDICAL CENTER WILLIAMSON
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665
Practice Address - Country:US
Practice Address - Phone:512-814-0298
Practice Address - Fax:512-597-2713
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-10-30
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Provider Licenses
StateLicense IDTaxonomies
TXN5415207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2866683Medicaid
TXTXB132498OtherMEDICARE