Healthcare Provider Details

I. General information

NPI: 1316200488
Provider Name (Legal Business Name): DANIEL STILWELL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO ST STE 202
DURANGO CO
81301-7307
US

IV. Provider business mailing address

1 MERCADO ST STE 202
DURANGO CO
81301-7307
US

V. Phone/Fax

Practice location:
  • Phone: 970-764-9400
  • Fax: 970-764-9449
Mailing address:
  • Phone: 970-764-9400
  • Fax: 970-764-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD.0000768
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: