Provider Demographics
NPI:1447233887
Name:HESS, STEPHANIE L (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:HESS
Suffix:
Gender:F
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 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:033-415-4155
Mailing Address - Fax:303-776-3109
Practice Address - Street 1:2101 KEN PRATT BLVD STE 104A
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6568
Practice Address - Country:US
Practice Address - Phone:303-415-4155
Practice Address - Fax:303-776-3109
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.133981207Q00000X
CODR.0040241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01252241Medicaid
COH60616Medicare UPIN
COP00138047Medicare PIN
COC528498Medicare PIN