Healthcare Provider Details

I. General information

NPI: 1487879482
Provider Name (Legal Business Name): KATHLEEN RUTH STIRLING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 OLD PECOS TRL
SANTA FE NM
87505-4776
US

IV. Provider business mailing address

3 LAGUNA LN
SANTA FE NM
87508-2242
US

V. Phone/Fax

Practice location:
  • Phone: 505-992-0233
  • Fax:
Mailing address:
  • Phone: 612-418-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2007-0024
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: