Provider Demographics
NPI:1184627697
Name:STINCHCOMB, DAVID ELLIS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELLIS
Last Name:STINCHCOMB
Suffix:
Gender:M
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:PO BOX 2278
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2278
Mailing Address - Country:US
Mailing Address - Phone:505-898-2255
Mailing Address - Fax:505-898-1370
Practice Address - Street 1:122 VIA OREADA
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-7434
Practice Address - Country:US
Practice Address - Phone:505-898-2255
Practice Address - Fax:505-898-1370
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM68-183207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2120177Medicare ID - Type Unspecified