Provider Demographics
NPI:1861575730
Name:LUDWIG, STEPHEN L (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:LUDWIG
Suffix:
Gender:M
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 10700
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-5517
Mailing Address - Country:US
Mailing Address - Phone:970-256-5285
Mailing Address - Fax:
Practice Address - Street 1:455 KOKOPELLI BLVD
Practice Address - Street 2:UNIT C
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-8710
Practice Address - Country:US
Practice Address - Phone:970-256-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01224815Medicaid
CO01224815Medicaid
CO297467YL92Medicare PIN