Active NPI
David Leedy Stoller, M.D.
- Family Medicine Physician
- Everett, WA
National Provider Identifier
1467525246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD00341141
- Practice address
- 3125 Colby Ave
Suite J
Everett, WA 98201-4032 - Phone
- (425) 303-8806
- Fax
- (425) 303-8848
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00341141 | WA | Primary |
| Obstetrics & Gynecology Physician | 207V00000X | MD00341141 | WA |
Addresses
Primary practice location
3125 Colby Ave
Suite J
Everett, WA 98201-4032
Mailing address
3125 Colby Ave
Suite J
Everett, WA 98201-4032
Phone (425) 303-8806
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8014102 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00341141 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Puget Sound Family Physicians | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Edmonds, WA
- NPI 1083643340
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321488000000",
"number": "1467525246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3125 COLBY AVE",
"address_2": "SUITE J",
"city": "EVERETT",
"state": "WA",
"postal_code": "982014032",
"telephone_number": "425-303-8806",
"fax_number": "425-303-8848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3125 COLBY AVE",
"address_2": "SUITE J",
"city": "EVERETT",
"state": "WA",
"postal_code": "982014032",
"telephone_number": "425-303-8806",
"fax_number": "425-303-8848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOLLER",
"first_name": "DAVID",
"middle_name": "LEEDY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2011-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD00341141",
"primary": true
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "WA",
"license": "MD00341141",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8014102",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.