Healthcare Provider Details

I. General information

NPI: 1336157460
Provider Name (Legal Business Name): LAURA R STERN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 JEFFERSON ST NE STE 300
ALBUQUERQUE NM
87109-4314
US

IV. Provider business mailing address

6100 PAN AMERICAN FREEWAY, NE SUITE 390
ALBUQUERQUE NM
87109-3401
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1114
  • Fax: 505-884-3004
Mailing address:
  • Phone: 505-823-1805
  • Fax: 505-823-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number92-360
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: