Healthcare Provider Details

I. General information

NPI: 1710919881
Provider Name (Legal Business Name): JOYCE ANN STIGGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FOSTER LANE
RESERVE NM
87830-0710
US

IV. Provider business mailing address

HC 60 BOX 517
QUEMADO NM
87829-9612
US

V. Phone/Fax

Practice location:
  • Phone: 575-533-6456
  • Fax: 575-533-6767
Mailing address:
  • Phone: 575-773-4321
  • Fax: 575-533-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2005-0322
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: