Provider Demographics
NPI:1336126788
Name:STOCKARD, HERBERT EUGENE (M D)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:EUGENE
Last Name:STOCKARD
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 NAVARRE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3223
Mailing Address - Country:US
Mailing Address - Phone:419-698-8560
Mailing Address - Fax:419-698-8570
Practice Address - Street 1:2702 NAVARRE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3223
Practice Address - Country:US
Practice Address - Phone:419-698-8560
Practice Address - Fax:419-698-8570
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 038070207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0323144Medicaid
OHE84212Medicare UPIN
OH0426136Medicare ID - Type Unspecified