Provider Demographics
NPI:1851385678
Name:NOLL, DAVID STOCKTON (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STOCKTON
Last Name:NOLL
Suffix:
Gender:M
Credentials:DO
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:59TH ORTHOPEDIC AND REHAB SQUADRON
Mailing Address - Street 2:2200 BERGQUIST DR STE 1
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:59TH ORTHOPEDIC AND REHAB SQUADRON
Practice Address - Street 2:2200 BERGQUIST DR STE 1
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO R7D51207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN