Healthcare Provider Details

I. General information

NPI: 1114077625
Provider Name (Legal Business Name): MARY M STENGEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RIVERGATE UNIT 210
DURANGO CO
81301-7488
US

IV. Provider business mailing address

PO BOX 15000
DURANGO CO
81302-8901
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-0042
  • Fax: 970-259-8837
Mailing address:
  • Phone: 970-259-2525
  • Fax: 970-247-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25329
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: