Provider Demographics
NPI:1952364531
Name:STOLLER, DAVID ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:STOLLER
Suffix:
Gender:M
Credentials:DPM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6585 S YALE AVE
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8384
Mailing Address - Country:US
Mailing Address - Phone:918-502-5300
Mailing Address - Fax:918-502-5301
Practice Address - Street 1:6585 S YALE AVE
Practice Address - Street 2:SUITE 1110
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8384
Practice Address - Country:US
Practice Address - Phone:918-502-5300
Practice Address - Fax:918-502-5301
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE 4700213ES0103X
OK270213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU90051Medicare UPIN
CA1952364531Medicare NSC