Individual
SCOTT T STOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, PHD
Contact information
Practice address
5717 EDWARDS RANCH RD, FORT WORTH, TX 76109-4116
(817) 294-3195
(817) 294-3466
Mailing address
5717 EDWARDS RANCH RD, FORT WORTH, TX 76109-4116
(817) 294-3195
(817) 294-3466
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
H9575
TX
208100000X
Physical Medicine & Rehabilitation Physician
Primary
H9575
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101368202
—
TX
05
—
101368205
—
TX
01
—
84W011
BCBS
TX
01
—
8CE992
BCBS
TX
Enumeration date
02/08/2006
Last updated
07/01/2013
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