Provider Demographics
NPI:1861447492
Name:STOLL, EMMA LOU (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LOU
Last Name:STOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32329-0580
Mailing Address - Country:US
Mailing Address - Phone:850-653-8853
Mailing Address - Fax:850-653-1897
Practice Address - Street 1:110 NE 5TH STREET
Practice Address - Street 2:
Practice Address - City:CARRABELLE
Practice Address - State:FL
Practice Address - Zip Code:32322-3529
Practice Address - Country:US
Practice Address - Phone:850-697-2345
Practice Address - Fax:850-653-1897
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92047207R00000X, 208D00000X
FLME9247208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276117300Medicaid
FLP00203892OtherRAILROAD MEDICARE
FL52373OtherBCBS
FL52373OtherBLUE CROSS BLUE SHIELD
FLH61562Medicare UPIN
FL276117300Medicaid