Provider Demographics
NPI:1790721447
Name:STOTZ, RONALD ALVIN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ALVIN
Last Name:STOTZ
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 1:1009 S MILAM ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4578
Mailing Address - Country:US
Mailing Address - Phone:830-990-0064
Mailing Address - Fax:830-990-1173
Practice Address - Street 1:1009 S MILAM ST
Practice Address - Street 2:SUITE 4
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4578
Practice Address - Country:US
Practice Address - Phone:830-990-0064
Practice Address - Fax:830-990-1173
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ98212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016AAMedicare ID - Type Unspecified
TXE83441Medicare UPIN