Healthcare Provider Details

I. General information

NPI: 1346343324
Provider Name (Legal Business Name): STEPHEN MARSHALL CORRIZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 ZAFARANO DRIVE SUITE C ASPEN MEDICAL GROUP, LLC
SANTA FE NM
87507-2669
US

IV. Provider business mailing address

3450 ZAFARANO DRIVE SUITE C ASPEN MEDICAL GROUP, LLC
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-5885
  • Fax: 505-466-5886
Mailing address:
  • Phone: 505-466-5885
  • Fax: 505-466-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA125764
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA125764
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: