Provider Demographics
NPI:1558330233
Name:STOLTZNER, GORDON H (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:H
Last Name:STOLTZNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3412
Mailing Address - Country:US
Mailing Address - Phone:941-953-3860
Mailing Address - Fax:
Practice Address - Street 1:2122 10TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-3412
Practice Address - Country:US
Practice Address - Phone:941-953-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 16538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB67194Medicare UPIN
FL26096Medicare ID - Type Unspecified