Provider Demographics
NPI:1619381894
Name:STOVER, ANTHONY EDWARD JR (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:STOVER
Suffix:JR
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 1:7975 LAKE UNDERHILL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8204
Mailing Address - Country:US
Mailing Address - Phone:407-303-8683
Mailing Address - Fax:407-303-8659
Practice Address - Street 1:7975 LAKE UNDERHILL RD STE 210
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8204
Practice Address - Country:US
Practice Address - Phone:407-303-8683
Practice Address - Fax:407-303-8659
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLUO4012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program