Provider Demographics
NPI:1770589673
Name:STOVALL, FELIX RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:FELIX
Middle Name:RUSSELL
Last Name:STOVALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3150 MEDICAL CENTER DR
Mailing Address - Street 2:STE 2
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4651
Mailing Address - Country:US
Mailing Address - Phone:409-838-0348
Mailing Address - Fax:409-838-2999
Practice Address - Street 1:3150 MEDICAL CENTER DR
Practice Address - Street 2:STE 2
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4651
Practice Address - Country:US
Practice Address - Phone:409-838-0348
Practice Address - Fax:409-838-2999
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE6636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B26728Medicare UPIN
00RF47Medicare ID - Type Unspecified