MEDICARE: SCOTT T STOLL DO PHD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	H9575	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0027TA	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912231408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT T STOLL DO PHD PA

Provider Business Mailing Address
First Line	:	5717 EDWARDS RANCH RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4116
Country	:	US
Telephone Number	:	817-294-3195
Fax Number	:	817-294-3466

Provider Business Practice Location Address
First Line	:	5717 EDWARDS RANCH RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4116
Country	:	US
Telephone Number	:	817-294-3195
Fax Number	:	817-294-3466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT T STOLL
Credential	:	D.O.
Telephone Number	:	817-294-3195

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	05/29/2014

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