Provider Demographics
NPI:1588755185
Name:STOLL, DANIEL LYNN (PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LYNN
Last Name:STOLL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2756
Mailing Address - Country:US
Mailing Address - Phone:520-459-3116
Mailing Address - Fax:520-459-7397
Practice Address - Street 1:1800 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2756
Practice Address - Country:US
Practice Address - Phone:520-459-3116
Practice Address - Fax:520-459-7397
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1478363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112946Medicaid
AZ100373Medicare ID - Type Unspecified
AZ112946Medicaid