Provider Demographics
NPI:1134115595
Name:STOVALL, RICHARD B (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:STOVALL
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:PO BOX 25887
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-0887
Mailing Address - Country:US
Mailing Address - Phone:512-835-8100
Mailing Address - Fax:512-835-8101
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:BLDG 2 STE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-835-8100
Practice Address - Fax:512-835-8101
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5409207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161400002Medicaid
TX8S5890OtherBC/BS INDIVIDUAL
TXH89476Medicare UPIN
TXH89476Medicare UPIN