Provider Demographics
NPI:1659590065
Name:STELZL, SHARON LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LEE
Last Name:STELZL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 N LESLIE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7211
Mailing Address - Country:US
Mailing Address - Phone:505-388-3393
Mailing Address - Fax:505-388-2696
Practice Address - Street 1:3185 N LESLIE RD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7211
Practice Address - Country:US
Practice Address - Phone:505-388-3393
Practice Address - Fax:505-388-2696
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA1294-05207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47029218Medicaid
NM47029218Medicaid