Provider Demographics
NPI:1942267232
Name:STOVALL, SUZANNE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:STOVALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4015 I H 45 N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5074
Mailing Address - Country:US
Mailing Address - Phone:936-270-4600
Mailing Address - Fax:936-856-8429
Practice Address - Street 1:4015 I H 45 N
Practice Address - Street 2:SUITE 100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5074
Practice Address - Country:US
Practice Address - Phone:936-270-4600
Practice Address - Fax:936-856-8429
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191030904Medicaid
TX8FT299OtherBLUE CROSS BLUE SHIELD
TX8FT299OtherBLUE CROSS BLUE SHIELD