{
"Npi": {
"NPI": "1346214202",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "STOLL",
"FirstName": "DAVID",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "P.A.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10512 N 110TH EAST AVE",
"SecondLineMailingAddress": "STE 220",
"MailingAddressCityName": "OWASSO",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74055-6636",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-376-8959",
"MailingAddressFaxNumber": "918-376-8999",
"FirstLinePracticeLocationAddress": "10512 N 110TH EAST AVE",
"SecondLinePracticeLocationAddress": "STE 220",
"PracticeLocationAddressCityName": "OWASSO",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "74055-6636",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "918-376-8959",
"PracticeLocationAddressFaxNumber": "918-376-8999",
"EnumerationDate": "02/15/2006",
"LastUpdateDate": "08/12/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "15-00911",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "15-00911",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": "15-00911",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "2678",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}