Provider Demographics
NPI:1427048867
Name:STILWELL, JOSEPH GREGORY (DPM)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GREGORY
Last Name:STILWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 RIVERGATE
Mailing Address - Street 2:#95
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7487
Mailing Address - Country:US
Mailing Address - Phone:970-259-5303
Mailing Address - Fax:970-259-3510
Practice Address - Street 1:575 RIVERGATE
Practice Address - Street 2:#95
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-259-5303
Practice Address - Fax:970-259-3510
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO380213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003805Medicaid
COT60338Medicare UPIN
CO3863730001Medicare NSC
CO50063Medicare ID - Type Unspecified