Basic Information
| Provider Information | |||||||||
| NPI: | 1740360114 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALAN STOCKARD PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ACADEMIC SPORTS CARE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1572 | ||||||||
| Address2: | |||||||||
| City: | RADFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241431572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406396736 | ||||||||
| FaxNumber: | 5406331524 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 PROFESSIONAL PARK DR SE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | BLACKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240606685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409514000 | ||||||||
| FaxNumber: | 5406331524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CONROY | ||||||||
| AuthorizedOfficialFirstName: | BEN | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5406331524 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204C00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine |
No ID Information.