Provider Demographics
NPI:1609844471
Name:STELZER, MATTHEW A (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:STELZER
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 1:1151 HOSPITAL WAY BLDG F
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5091
Mailing Address - Country:US
Mailing Address - Phone:208-232-1443
Mailing Address - Fax:208-239-3434
Practice Address - Street 1:1151 HOSPITAL WAY BLDG F
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5091
Practice Address - Country:US
Practice Address - Phone:208-232-1443
Practice Address - Fax:208-239-3434
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-12936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808342900Medicaid
H17318Medicare UPIN
1974572OtherUHC
PROVP16343OtherMOLINA
NMNM009J47OtherBCBS NM
33314OtherLOVELACE
NM22322213Medicaid
NM341409703Medicare PIN