Provider Demographics
NPI:1528147675
Name:STERNBERG, PATRICK EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:EUGENE
Last Name:STERNBERG
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 47
Mailing Address - Street 2:
Mailing Address - City:LA VETA
Mailing Address - State:CO
Mailing Address - Zip Code:81055-0047
Mailing Address - Country:US
Mailing Address - Phone:719-742-5100
Mailing Address - Fax:719-742-5244
Practice Address - Street 1:139 W. RYUS AVENUE
Practice Address - Street 2:
Practice Address - City:LAVETA
Practice Address - State:CO
Practice Address - Zip Code:81055
Practice Address - Country:US
Practice Address - Phone:719-742-5100
Practice Address - Fax:719-742-5244
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO226152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22615OtherCOLORADO LICENSE
CO01226158Medicaid
CO22615OtherCOLORADO LICENSE