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Individual

STEPHEN MACKERROW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
407 S SCHWARTZ AVE STE 202, FARMINGTON, NM 87401-5925
(505) 609-6770
(505) 609-6775
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259

Taxonomy

Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
31635
CO
207RI0011X
Interventional Cardiology Physician
Primary
87-365
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01316355
CO
01
P00986966
RAILROAD MEDICARE
CO
Enumeration date
06/02/2006
Last updated
11/08/2024
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