Individual
FREDERICK DAVIS STOCKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 N. PROGRESS DR., XENIA, OH 45385
(937) 374-4040
(937) 374-4020
Mailing address
50 N. PROGRESS DR., XENIA, OH 45385
(937) 374-4040
(937) 374-4020
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35043256
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000012506
ANTHEM
OH
05
—
0402317
—
OH
01
—
P00432937
RAILROAD MEDICARE
OH
Enumeration date
07/15/2005
Last updated
04/02/2008
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