Individual
DR. STEFANOS BOUKOVALAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
62868
TN
208200000X
Plastic Surgery Physician
BP10052157
TX
208200000X
Plastic Surgery Physician
BP20066599
TX
208600000X
Surgery Physician
MT202718
PA
Other
Enumeration date
07/28/2012
Last updated
04/11/2022
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