Provider Demographics
NPI:1649931247
Name:STOVER, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:STOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2749 W ROY FURMAN HWY
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-2557
Mailing Address - Country:US
Mailing Address - Phone:724-747-5875
Mailing Address - Fax:
Practice Address - Street 1:2749 W ROY FURMAN HWY
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-2557
Practice Address - Country:US
Practice Address - Phone:724-747-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86-1819842171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor