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NPI Code Detail

MEDICARE: TERI GLEE STEVENSON MD

MEDICARE: TERI GLEE STEVENSON MD
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
1208000000XPediatrics Physician39689WI
2208000000XPediatrics Physician0063531CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235118498
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERI GLEE STEVENSON MD
Provider Business Mailing Address
First Line : 53 CLIFFROSE WAY
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-6705
Country : US
Telephone Number : 715-579-6246
Fax Number :
Provider Business Practice Location Address
First Line : 1905 BLAKE AVE STE 201
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4286
Country : US
Telephone Number : 970-947-9999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2006
Last Update Date : 08/25/2020

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Directions to “ TERI GLEE STEVENSON MD” Practice Location

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