Healthcare Provider Details

I. General information

NPI: 1861642654
Provider Name (Legal Business Name): ELITE FOOTCARE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6585 S YALE AVE SUITE 1110
TULSA OK
74136-8384
US

IV. Provider business mailing address

6585 S YALE AVE SUITE 1110
TULSA OK
74136-8384
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-5300
  • Fax: 918-502-5301
Mailing address:
  • Phone: 918-502-5300
  • Fax: 918-502-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE 4700
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID ALAN STOLLER
Title or Position: PRESIDENT
Credential: DPM
Phone: 918-502-5300