Provider Demographics
NPI:1316200488
Name:STILWELL, DANIEL (DPM)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STILWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCADO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7307
Mailing Address - Country:US
Mailing Address - Phone:970-764-9400
Mailing Address - Fax:970-764-9449
Practice Address - Street 1:1 MERCADO ST STE 202
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7307
Practice Address - Country:US
Practice Address - Phone:970-764-9400
Practice Address - Fax:970-764-9449
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000768213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program