MEDICARE: DR. DAVID ELLIS STINCHCOMB M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	68-183	NM

General Provider Information

NPI Number	:	1184627697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ELLIS STINCHCOMB M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2278
Second Line	:
City	:	CORRALES
State	:	NM
Zip	:	87048-2278
Country	:	US
Telephone Number	:	505-898-2255
Fax Number	:	505-898-1370

Provider Business Practice Location Address
First Line	:	122 VIA OREADA
Second Line	:
City	:	CORRALES
State	:	NM
Zip	:	87048-7434
Country	:	US
Telephone Number	:	505-898-2255
Fax Number	:	505-898-1370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. DAVID ELLIS STINCHCOMB M.D.” Practice Location

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