Provider Demographics
NPI:1457551012
Name:MEBANE, MARY V (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:V
Last Name:MEBANE
Suffix:
Gender:F
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 52
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-0052
Mailing Address - Country:US
Mailing Address - Phone:970-252-8896
Mailing Address - Fax:970-240-3095
Practice Address - Street 1:87 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3015
Practice Address - Country:US
Practice Address - Phone:970-252-8896
Practice Address - Fax:970-240-3095
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00416434OtherRAILROAD MEDICARE
CO49451766Medicaid
CO49451766Medicaid