Provider Demographics
NPI:1063426393
Name:STOVALL, TROY W (DO)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:W
Last Name:STOVALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1212 DREAMVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-0616
Mailing Address - Country:US
Mailing Address - Phone:865-288-0223
Mailing Address - Fax:865-288-0223
Practice Address - Street 1:423 MEDICAL PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5640
Practice Address - Country:US
Practice Address - Phone:865-271-6600
Practice Address - Fax:865-271-6601
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02001581A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020834Medicaid
IN100464880Medicaid
IN000000722508OtherANTHEM TRADITIONAL
IN100464880Medicaid
INF90888Medicare UPIN