Provider Demographics
NPI:1790843779
Name:DE STEFANO, PAUL MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARIO
Last Name:DE STEFANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1650 HOSPITAL DR
Mailing Address - Street 2:SUITE #500
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4769
Mailing Address - Country:US
Mailing Address - Phone:505-954-4290
Mailing Address - Fax:505-954-4058
Practice Address - Street 1:1650 HOSPITAL DR
Practice Address - Street 2:SUITE #500
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4769
Practice Address - Country:US
Practice Address - Phone:505-954-4290
Practice Address - Fax:505-954-4058
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NM98-39207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine