Provider Demographics
NPI:1811313497
Name:STOVALL, CHRISTOPHER B SR
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:STOVALL
Suffix:SR
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 1:7910 CRESCENT HILL CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5700
Mailing Address - Country:US
Mailing Address - Phone:907-529-6546
Mailing Address - Fax:
Practice Address - Street 1:7910 CRESCENT HILL CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5700
Practice Address - Country:US
Practice Address - Phone:907-529-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other