Individual
MR. STEPHEN J DOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1255 LIBERTY STREET, REDDING, CA 96001-0814
(530) 246-2467
(530) 242-9460
Mailing address
PO BOX 991950, REDDING, CA 96099-1950
(530) 246-2467
(530) 242-9460
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA13839
CA
363AS0400X
Surgical Physician Assistant
Primary
PA13839
CA
363L00000X
Nurse Practitioner
6393
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680310525
GROUP TAX ID
CA
05
—
GR0079250
—
CA
Enumeration date
11/21/2006
Last updated
04/06/2021
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