MEDICARE: JOSEPH GREGORY STILWELL DPM

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	213E00000X	Podiatrist	380	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1427048867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH GREGORY STILWELL DPM

Provider Business Mailing Address
First Line	:	575 RIVERGATE
Second Line	:	#95
City	:	DURANGO
State	:	CO
Zip	:	81301-7487
Country	:	US
Telephone Number	:	970-259-5303
Fax Number	:	970-259-3510

Provider Business Practice Location Address
First Line	:	575 RIVERGATE
Second Line	:	#95
City	:	DURANGO
State	:	CO
Zip	:	81301-7487
Country	:	US
Telephone Number	:	970-259-5303
Fax Number	:	970-259-3510

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	04/26/2010

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