Provider Demographics
NPI:1184647000
Name:STERN, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7300
Mailing Address - Country:US
Mailing Address - Phone:970-247-4448
Mailing Address - Fax:970-382-6607
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 220
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-247-4448
Practice Address - Fax:970-382-6607
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO34148208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01341486Medicaid
CO01341486Medicaid
COCC1938Medicare ID - Type Unspecified