MEDICARE: DR. ROGER KENNETH STOLTZMAN M.D.

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	2084P0800X	Psychiatry Physician	G41448	CA

General Provider Information

NPI Number	:	1578546057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER KENNETH STOLTZMAN M.D.

Provider Business Mailing Address
First Line	:	2505 W 14TH ST
Second Line	:	OAKLAND ARMY BASE
City	:	OAKLAND
State	:	CA
Zip	:	94607-5031
Country	:	US
Telephone Number	:	510-587-3427
Fax Number	:	510-587-3455

Provider Business Practice Location Address
First Line	:	2505 W 14TH ST
Second Line	:	OAKLAND ARMY BASE
City	:	OAKLAND
State	:	CA
Zip	:	94607-5031
Country	:	US
Telephone Number	:	510-587-3427
Fax Number	:	510-587-3455

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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