Active NPI
George A Stovall Jr., MD
- Gastroenterology Physician
- Waco, TX
National Provider Identifier
1770533903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- H1726
- Practice address
- 405 Londonderry Dr
Suite 303
Waco, TX 76712-7924 - Phone
- (254) 399-6730
- Fax
- (254) 399-6738
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | H1726 | TX | Primary |
Addresses
Primary practice location
405 Londonderry Dr
Suite 303
Waco, TX 76712-7924
Mailing address
405 Londonderry Dr
Suite 303
Waco, TX 76712-7924
Phone (254) 399-6730
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 133165410 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H1726 | TX | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330992000000",
"number": "1770533903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 LONDONDERRY DR",
"address_2": "SUITE 303",
"city": "WACO",
"state": "TX",
"postal_code": "767127924",
"telephone_number": "254-399-6730",
"fax_number": "254-399-6738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 LONDONDERRY DR",
"address_2": "SUITE 303",
"city": "WACO",
"state": "TX",
"postal_code": "767127924",
"telephone_number": "254-399-6730",
"fax_number": "254-399-6738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOVALL",
"first_name": "GEORGE",
"middle_name": "A",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2012-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "TX",
"license": "H1726",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "133165410",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.