Healthcare Provider Details

I. General information

NPI: 1134117484
Provider Name (Legal Business Name): MARJORIE CRISTOL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 MAIN AVENUE DURANGO HIGH SCHOOL
DURANGO CO
81301
US

IV. Provider business mailing address

281 SAWYER DR STE 100
DURANGO CO
81303-3409
US

V. Phone/Fax

Practice location:
  • Phone: 970-946-2712
  • Fax:
Mailing address:
  • Phone: 970-259-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34342
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: