Healthcare Provider Details

I. General information

NPI: 1316930761
Provider Name (Legal Business Name): DAVID A. STOLTZE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 HOT SPRINGS BLVD
LAS VEGAS NM
87701-4120
US

IV. Provider business mailing address

111 N RAILROAD AVE P.O. BOX 158
ESPANOLA NM
87532-2627
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6788
  • Fax: 505-425-5408
Mailing address:
  • Phone: 505-753-7218
  • Fax: 505-753-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81-322
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: