1134117484 NPI number — MARJORIE CRISTOL MD

Table of content: MARJORIE CRISTOL MD (NPI 1134117484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134117484 NPI number — MARJORIE CRISTOL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRISTOL
Provider First Name:
MARJORIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134117484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
281 SAWYER DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81303-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-259-2162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2390 MAIN AVENUE
Provider Second Line Business Practice Location Address:
DURANGO HIGH SCHOOL
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-946-2712
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34342 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 84070694599 . This is a "ROCKY MOUNTAIN HEALTH PLA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: E8545 . This is a "NEW MEXICO MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: T0835 . This is a "MEDICAID OF UTAH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201018475 . This is a "PRESBYTERIAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: CR34638 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 00X750 . This is a "BCBS OF NEW MEXICO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01343425 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080170038 . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8407094577 . This is a "PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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