Kenneth Paul Stoller, MD

Primary specialty

Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X

License

97382 Issued in NM

Practice address

330 Paseo del Pueblo Sur Ste J
Taos, NM 87571-5328

Phone

(505) 288-9155

NPI assigned

Sep 16, 2006

Last updated

Mar 18, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hyperbaric Medical Center of New Mexico Inc

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Santa Fe, NM
  • NPI 1902009756
  NPD (past)
• Azzolino Chiropractic Neurology & Integrative Wellness, Inc

  • Neurology Chiropractor
  • San Francisco, CA
  • NPI 1730223371
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1063518967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 PASEO DEL PUEBLO SUR STE J",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875715328",
            "telephone_number": "505-288-9155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 PASEO DEL PUEBLO SUR STE J",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875715328",
            "telephone_number": "505-288-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLLER",
        "first_name": "KENNETH",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "CA",
            "license": "A41183",
            "primary": false
        },
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "NM",
            "license": "97382",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "97382",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A41183",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z7406",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen D Cetrulo MD
• Elizabeth Weston Stern, LMHC
• David William Stevens, DDS
• Stillwater Counseling LLC
• Laurel Stokes, RN
• Vonne Strobbe, MSHED
• Garrett Daniel Stroud, RPH
• Erick A Struck, LISW
• Brandon Suazo
• Nathan Joe Suazo, CPSW

• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in Taos, NM
• Providers in Taos, NM by specialty
• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.