Provider Demographics
NPI:1356356281
Name:STOVALL, ISAAC H (M D)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:H
Last Name:STOVALL
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:PO BOX 1409
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-4409
Mailing Address - Country:US
Mailing Address - Phone:931-728-5420
Mailing Address - Fax:931-728-5420
Practice Address - Street 1:481 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3108
Practice Address - Country:US
Practice Address - Phone:931-728-6354
Practice Address - Fax:931-728-5420
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD21063207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3882581Medicaid
TNE74775Medicare UPIN
TN3882581Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER