Provider Demographics
NPI:1770533903
Name:STOVALL, GEORGE A JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:STOVALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:405 LONDONDERRY DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7924
Mailing Address - Country:US
Mailing Address - Phone:254-399-6730
Mailing Address - Fax:254-399-6738
Practice Address - Street 1:405 LONDONDERRY DR
Practice Address - Street 2:SUITE 303
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7924
Practice Address - Country:US
Practice Address - Phone:254-399-6730
Practice Address - Fax:254-399-6738
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH1726207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133165410Medicaid
TXC22331Medicare UPIN
TX133165410Medicaid