Provider Demographics
NPI:1962592485
Name:STOVALL, DALE WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:WILLIAM
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 1:122 W COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2382
Mailing Address - Country:US
Mailing Address - Phone:214-947-6700
Mailing Address - Fax:214-947-6701
Practice Address - Street 1:122 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2382
Practice Address - Country:US
Practice Address - Phone:214-947-6700
Practice Address - Fax:214-947-6701
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058522207VE0102X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV3453AMedicare PIN
E17916Medicare UPIN
VAP01003432Medicare PIN
VAVV3453BMedicare PIN
VA1962592485Medicaid