Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | H9575 | TX |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | H9575 | TX |
NPI | 1275506644 |
---|---|
Provider Name | Scott T Stoll |
First Address | Fort Worth, TX 76109-4116 |
Second Address | Fort Worth, TX 76109-4116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 01/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101368202 | (05) | TX |
101368205 | (05) | TX |
84W011 | BCBS (01) | TX |
8CE992 | BCBS (01) | TX |
E98001 | (02) | TX |