Provider Demographics
NPI:1134117484
Name:CRISTOL, MARJORIE (MD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:CRISTOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 SAWYER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-3409
Mailing Address - Country:US
Mailing Address - Phone:970-259-2162
Mailing Address - Fax:
Practice Address - Street 1:2390 MAIN AVENUE
Practice Address - Street 2:DURANGO HIGH SCHOOL
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-946-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84070694599OtherROCKY MOUNTAIN HEALTH PLA
E8545OtherNEW MEXICO MEDICAID
T0835OtherMEDICAID OF UTAH
201018475OtherPRESBYTERIAN HEALTH PLAN
COCR34638OtherANTHEM BCBS
00X750OtherBCBS OF NEW MEXICO
CO01343425Medicaid
080170038OtherTRAVELERS MEDICARE
CO8407094577OtherPACIFICARE
080170038OtherTRAVELERS MEDICARE
246688Medicare ID - Type Unspecified