MEDICARE: WINONA STOLTZFUS MD

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	208000000X	Pediatrics Physician	2001-110	NM
2	2083P0901X	Public Health & General Preventive Medicine Physician	2001-110	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053387811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINONA STOLTZFUS MD

Provider Business Mailing Address
First Line	:	300 SAN MATEO BLVD NE STE 902
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-1507
Country	:	US
Telephone Number	:	505-222-8684
Fax Number	:	505-222-8675

Provider Business Practice Location Address
First Line	:	300 SAN MATEO BLVD NE STE 902
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-1507
Country	:	US
Telephone Number	:	505-222-8684
Fax Number	:	505-222-8675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/18/2014

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