Provider Demographics
NPI:1144282054
Name:STOVER, GREGORY L (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:STOVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435-0001
Mailing Address - Country:US
Mailing Address - Phone:937-245-7100
Mailing Address - Fax:937-245-7999
Practice Address - Street 1:1529 FAIR RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8193
Practice Address - Country:US
Practice Address - Phone:937-497-9810
Practice Address - Fax:937-497-1334
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003521207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0541793Medicaid
OH0541793Medicaid
OHST0626483Medicare ID - Type Unspecified