Basic Information
| Provider Information | |||||||||
| NPI: | 1134117484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRISTOL | ||||||||
| FirstName: | MARJORIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 281 SAWYER DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813033409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702592162 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2390 MAIN AVENUE | ||||||||
| Address2: | DURANGO HIGH SCHOOL | ||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709462712 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34342 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 84070694599 | 01 | CO | ROCKY MOUNTAIN HEALTH PLA | OTHER | E8545 | 01 | NEW MEXICO MEDICAID | OTHER | T0835 | 01 | MEDICAID OF UTAH | OTHER | 201018475 | 01 | PRESBYTERIAN HEALTH PLAN | OTHER | CR34638 | 01 | CO | ANTHEM BCBS | OTHER | 00X750 | 01 | BCBS OF NEW MEXICO | OTHER | 01343425 | 05 | CO | MEDICAID | 080170038 | 01 | TRAVELERS MEDICARE | OTHER | 8407094577 | 01 | CO | PACIFICARE | OTHER |