Provider Demographics
NPI:1417987850
Name:STOCKARD, ALAN R (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:STOCKARD
Suffix:
Gender:M
Credentials:DO
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 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:817-735-2235
Mailing Address - Fax:817-735-2480
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-735-2235
Practice Address - Fax:817-735-2480
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6970208D00000X, 207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX847561OtherBCBS
TXP00633587OtherMEDICARE RR
TX132469109Medicaid
TX8BM390OtherBCBS
TXP00768237OtherRAILROAD MEDICARE
TX132469110Medicaid
TXP00768237OtherRAILROAD MEDICARE
TX132469110Medicaid
TX847561OtherBCBS