Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 19225 | SC |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 19225 | SC |
NPI | 1003844523 |
---|---|
Provider Name | Don Owen Stovall JR. |
First Address | North Charleston, SC 29406-9171 |
Second Address | North Charleston, SC 29406-9171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1326287434 | MEDICAID DME NPI (01) | SC |
20076508 | SELECT HEALTH DME (01) | SC |
G31114 | (02) | SC |
T31766 | (05) | SC |