Provider Demographics
NPI:1619091584
Name:STONE M. HALLQUIST M. D. INC.
Entity Type:Organization
Organization Name:STONE M. HALLQUIST M. D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STONE
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HALLQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-494-9440
Mailing Address - Street 1:6565 S YALE AVE
Mailing Address - Street 2:SUITE 912
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8378
Mailing Address - Country:US
Mailing Address - Phone:918-494-9440
Mailing Address - Fax:918-494-9473
Practice Address - Street 1:6565 S YALE AVE
Practice Address - Street 2:SUITE 912
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8378
Practice Address - Country:US
Practice Address - Phone:918-494-9440
Practice Address - Fax:918-494-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK91992088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty