Provider Demographics
NPI:1780697300
Name:STOGNER, LINDA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARIE
Last Name:STOGNER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:701 ALLEN
Mailing Address - City:ESTANCIA
Mailing Address - State:NM
Mailing Address - Zip Code:87016-0158
Mailing Address - Country:US
Mailing Address - Phone:505-384-5068
Mailing Address - Fax:505-384-2204
Practice Address - Street 1:ESPERANZA FAMILY HEALTH CENTER
Practice Address - Street 2:903 C FIFTH ST
Practice Address - City:ESTANCIA
Practice Address - State:NM
Practice Address - Zip Code:87016
Practice Address - Country:US
Practice Address - Phone:505-384-2777
Practice Address - Fax:505-384-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM86-377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10000284OtherLOVELACE HEALTH PLAN
NM37648Medicaid
NM201009665OtherPRESBYTERIAN HEALTH PLAN
NM80147920OtherRAILROAD MEDICARE
NMNM002714OtherBLUECROSSBLUESHIELD OF NEW MEXICO
NM1727557OtherUNITED HEALTHCARE
NM850206810OtherTRICARE
NMPROVP16276OtherMOLINA HEALTHCARE
NM850206810OtherTRICARE
NM321843Medicare ID - Type Unspecified