Healthcare Provider Details

I. General information

NPI: 1235118498
Provider Name (Legal Business Name): TERI GLEE STEVENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 BLAKE AVE STE 201
GLENWOOD SPRINGS CO
81601-4286
US

IV. Provider business mailing address

53 CLIFFROSE WAY
GLENWOOD SPRINGS CO
81601-6705
US

V. Phone/Fax

Practice location:
  • Phone: 970-947-9999
  • Fax:
Mailing address:
  • Phone: 715-579-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39689
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0063531
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: