Provider Demographics
NPI:1861525792
Name:URSTADT, DONNA DIANNE STOVALL (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:DIANNE STOVALL
Last Name:URSTADT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:DIANNE STOVALL
Other - Last Name:GABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:YAMHILL
Mailing Address - State:OR
Mailing Address - Zip Code:97148-0597
Mailing Address - Country:US
Mailing Address - Phone:503-662-5007
Mailing Address - Fax:503-681-1903
Practice Address - Street 1:335 SE 8TH AVE
Practice Address - Street 2:TUALITY COMMUNITY HOSPITAL PATHOLOGY DEPARTMENT
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123
Practice Address - Country:US
Practice Address - Phone:503-681-1150
Practice Address - Fax:503-681-1903
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 19683207ZP0102X
GA030461207ZP0102X
AL14495207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133956Medicaid
ORR107886Medicare PIN
OR133956Medicaid