Provider Demographics
NPI:1770542318
Name:STOVER, PHILLIP EARL (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:EARL
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:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-0239
Mailing Address - Country:US
Mailing Address - Phone:919-496-1247
Mailing Address - Fax:919-496-3307
Practice Address - Street 1:1501 N BICKETT BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2178
Practice Address - Country:US
Practice Address - Phone:919-496-1247
Practice Address - Fax:919-496-3307
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC202922FMedicare ID - Type Unspecified
C81565Medicare UPIN