Healthcare Provider Details

I. General information

NPI: 1548722655
Provider Name (Legal Business Name): JODI DESIREE' STURGEON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI DESIREE' FITZGERALD MD

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 SOUTH 4TH ST
KREMMLING CO
80459
US

IV. Provider business mailing address

214 S 4TH ST
KREMMLING CO
80459-5065
US

V. Phone/Fax

Practice location:
  • Phone: 970-724-3442
  • Fax:
Mailing address:
  • Phone: 970-724-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0064969
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: