Provider Demographics
NPI:1114193240
Name:MAYER, STOCKTON MCQUADE (DO)
Entity Type:Individual
Prefix:DR
First Name:STOCKTON
Middle Name:MCQUADE
Last Name:MAYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S WOOD ST RM 888
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7300
Mailing Address - Country:US
Mailing Address - Phone:703-282-2241
Mailing Address - Fax:
Practice Address - Street 1:808 S WOOD ST
Practice Address - Street 2:ROOM 888 MC 735
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7300
Practice Address - Country:US
Practice Address - Phone:312-996-6763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.128020207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease