Healthcare Provider Details

I. General information

NPI: 1780697300
Provider Name (Legal Business Name): LINDA MARIE STOGNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESPERANZA FAMILY HEALTH CENTER 903 C FIFTH ST
ESTANCIA NM
87016
US

IV. Provider business mailing address

PO BOX 158 701 ALLEN
ESTANCIA NM
87016-0158
US

V. Phone/Fax

Practice location:
  • Phone: 505-384-2777
  • Fax: 505-384-2204
Mailing address:
  • Phone: 505-384-5068
  • Fax: 505-384-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86-377
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: