Healthcare Provider Details

I. General information

NPI: 1114418381
Provider Name (Legal Business Name): JUSTIS STOLZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 CENTRAL AVE STE 102A
KEARNEY NE
68847-2949
US

IV. Provider business mailing address

3219 CENTRAL AVE STE 102A
KEARNEY NE
68847-2949
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2600
  • Fax: 308-865-2990
Mailing address:
  • Phone: 308-865-2600
  • Fax: 308-865-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number37343
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number55283
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55283
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: