Provider Demographics
NPI:1912922345
Name:STOVALL, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:STOVALL
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 372
Mailing Address - Street 2:DEPT. 10
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0372
Mailing Address - Country:US
Mailing Address - Phone:901-202-6120
Mailing Address - Fax:
Practice Address - Street 1:7800 WOLF TRAIL COVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1753
Practice Address - Country:US
Practice Address - Phone:901-682-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15033207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119168Medicaid
TN4077771OtherBCBS TN
AR90060OtherBCBS AR
TN3835168Medicaid
4106873OtherAETNA HMO
LA1524956Medicaid
2570281OtherCIGNA
TNP00245008OtherRAILROAD MEDICARE
TNP00245008OtherRAILROAD MEDICARE
LA1524956Medicaid