Individual
DAVID STOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
10512 N 110TH EAST AVE, STE 220, OWASSO, OK 74055-6636
(918) 376-8959
(918) 376-8999
Mailing address
10512 N 110TH EAST AVE, STE 220, OWASSO, OK 74055-6636
(918) 376-8959
(918) 376-8999
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-00911
KS
363A00000X
Physician Assistant
Primary
2678
OK
363AM0700X
Medical Physician Assistant
15-00911
KS
363AS0400X
Surgical Physician Assistant
15-00911
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100643000A
—
KS
05
—
100643000E
—
KS
Enumeration date
02/15/2006
Last updated
08/12/2016
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