Provider Demographics
NPI:1740267004
Name:STOVER, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:STOVER
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 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5021
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:476 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-9602
Practice Address - Country:US
Practice Address - Phone:330-841-4000
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065864207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0960152Medicaid
OH000000269018OtherANTHEM
OH000000269069OtherANTHEM
OH001525638-0003OtherPENNSYLVANIA MEDICAID
OH000000385522OtherANTHEM
OHN367365OtherWELLCARE
OH000000385522OtherANTHEM
OH000000269018OtherANTHEM
OH0960152Medicaid
OHST0835596Medicare PIN
OHP00317891Medicare PIN
OHST0835598Medicare PIN
OHST0835597Medicare PIN