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NPI Code Detail

MEDICARE: DR. JOHN SANDERS STOLTZ M.D.

MEDICARE: DR. JOHN SANDERS STOLTZ 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
1207L00000XAnesthesiology PhysicianME39110FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105470OTHERFLBCBSFL

General Provider Information

NPI Number : 1205847001
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN SANDERS STOLTZ M.D.
Provider Business Mailing Address
First Line : 538 LANTERNBACK ISLAND DR
Second Line :
City : SATELLITE BEACH
State : FL
Zip : 32937-4712
Country : US
Telephone Number : 321-777-8300
Fax Number :
Provider Business Practice Location Address
First Line : 611 ZEAGLER DR
Second Line :
City : PALATKA
State : FL
Zip : 32177-3810
Country : US
Telephone Number : 321-777-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 07/08/2007

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