MEDICARE: DR. WOLF HEINRICH STAPELFELDT 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	207L00000X	Anesthesiology Physician	ME75331	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME75331	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42878	OTHER	FL	BLUECROSS/BLUESHIELD

General Provider Information

NPI Number	:	1770570061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WOLF HEINRICH STAPELFELDT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJP ANESTHESIA DEPT.
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-5431
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 W 8TH ST
Second Line	:	UFJP ANESTHESIA DEPT.
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-5431
Fax Number	:	904-244-3425

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

Provider Enumeration Date	:	10/01/2005
Last Update Date	:	08/26/2007

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