Provider Demographics
NPI:1104027333
Name:GAIL D STOCKMAN MD, PA
Entity type:Organization
Organization Name:GAIL D STOCKMAN MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:STOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-253-3430
Mailing Address - Street 1:303 W LOOP 281 STE 110
Mailing Address - Street 2:BOX # 193
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4444
Mailing Address - Country:US
Mailing Address - Phone:406-253-3430
Mailing Address - Fax:
Practice Address - Street 1:815 N 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5442
Practice Address - Country:US
Practice Address - Phone:406-253-3430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty