Individual
STEPHEN SAMUEL HAVERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1010 THREE SPRINGS BLVD, DURANGO, CO 81301-8296
(303) 306-7783
(303) 306-7753
Mailing address
PO BOX 17752, DENVER, CO 80217-0752
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
42845
CO
207P00000X
Emergency Medicine Physician
A77557
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A775570
—
CA
05
—
33457271
—
CO
05
—
77988230
—
NM
01
—
P00678278
PAILROAD MEDICARE PIN
CO
Enumeration date
08/23/2006
Last updated
04/03/2014
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