Provider Demographics
NPI:1588663371
Name:STOLOW, JOSHUA B (M D)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:B
Last Name:STOLOW
Suffix:
Gender:M
Credentials:M D
Other - Prefix:MR
Other - First Name:JOSHUA
Other - Middle Name:B
Other - Last Name:STOLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8527 VILLAGE DR
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5513
Mailing Address - Country:US
Mailing Address - Phone:210-590-9596
Mailing Address - Fax:210-693-1559
Practice Address - Street 1:8527 VILLAGE DR
Practice Address - Street 2:STE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5513
Practice Address - Country:US
Practice Address - Phone:210-590-9596
Practice Address - Fax:210-693-1559
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8446174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127424302Medicaid
TX127424302Medicaid
TX272571855OtherGROUP TAX ID NUMBER
TXTXB114210Medicare PIN
TX127424302Medicaid
TX363632588OtherTAX ID NUMBER