Healthcare Provider Details

I. General information

NPI: 1457551012
Provider Name (Legal Business Name): MARY V MEBANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MERCHANT DR
MONTROSE CO
81401-3015
US

IV. Provider business mailing address

PO BOX 52
MONTROSE CO
81402-0052
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-8896
  • Fax: 970-240-3095
Mailing address:
  • Phone: 970-252-8896
  • Fax: 970-240-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46285
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: