Provider Demographics
NPI:1558348870
Name:STOLTZ, RANDALL R (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:R
Last Name:STOLTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:801 SAINT MARYS DR
Mailing Address - Street 2:SUITE 110-E
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0511
Mailing Address - Country:US
Mailing Address - Phone:812-485-1895
Mailing Address - Fax:812-485-1844
Practice Address - Street 1:801 SAINT MARYS DR
Practice Address - Street 2:SUITE 110-E
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0511
Practice Address - Country:US
Practice Address - Phone:812-485-1895
Practice Address - Fax:812-485-1844
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01033825A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D70824Medicare UPIN