Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 036.103835 | IL |
NPI | 1255318036 |
---|---|
Provider Name | Dr. David W Stoller |
First Address | Novato, CA 94948-6102 |
Second Address | San Francisco, CA 94118-1618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 01/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0144894 | L&I (01) | WA |
111845 | (05) | AZ |
1255318036 | (05) | NV |
200097670A | (05) | OK |
300121756 | RAILROAD MEDICARE (01) | CA |
300123273 | RAILROAD MEDICARE (01) | WA |
8169690 | (05) | WA |
8933500 | L&I, CVCP (01) | WA |
8940207 | (05) | NJ |
93723288 | (05) | CO |
CE959P | (02) | CA |
E54828 | (02) | NJ |
G00508340 | (05) | CA |