Individual
DR. KENNETH PAUL STOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
330 PASEO DEL PUEBLO SUR STE J, TAOS, NM 87571-5328
(505) 288-9155
Mailing address
330 PASEO DEL PUEBLO SUR STE J, TAOS, NM 87571-5328
(505) 288-9155
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
97382
NM
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
A41183
CA
208000000X
Pediatrics Physician
97382
NM
208000000X
Pediatrics Physician
A41183
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z7406
—
NM
Enumeration date
09/16/2006
Last updated
03/18/2021
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