Provider Demographics
NPI:1134117278
Name:KOREC, STEFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:
Last Name:KOREC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8700
Mailing Address - Country:US
Mailing Address - Phone:575-443-7403
Mailing Address - Fax:
Practice Address - Street 1:2559 MEDICAL DR
Practice Address - Street 2:SUITE G.
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:575-437-8126
Practice Address - Fax:575-437-8205
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-57207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME1125Medicaid
NME1125Medicaid
NM900521250Medicare PIN