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NPI Code Detail

MEDICARE: DR. JEFFREY RONALD STOLTENBERG MD

MEDICARE: DR. JEFFREY RONALD STOLTENBERG 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
1208600000XSurgery PhysicianG5655TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AMERIGROUPOTHERTXAMERIGROUP
210011289OTHERTXSUPERIOR CHIPS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558364612
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY RONALD STOLTENBERG MD
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 NORTH PARK ST
Second Line :
City : BRENHAM
State : TX
Zip : 77833-2610
Country : US
Telephone Number : 979-836-6153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 03/04/2026

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