Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Stephanie M Dettlebach, MD

Individual provider Family Medicine Physician · NPI 1629145990

Dr. Stephanie M Dettlebach, MD is a Family Practice in Longmont, Colorado. Graduated from Wright State University Boonshoft School of Medicine in 1996, 30 years ago. Practices with Poudre Valley Medical Group LLC, a 2,416-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Colorado and Missouri.

Years since qualifying
30
Trained at
Wright State University Boonshoft School of Medicine
Licensed in
CO, MO
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone: (303) 776-1234
Fax: (720) 494-3107
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence DR.0057193 (CO)
Family Medicine Physician Taxonomy 207Q00000X · Licence 2009012781 (MO)

Record details

NPI number1629145990
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedNovember 29, 2006
Last updated in NPPESJuly 12, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolWRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE
Graduated 1996 (30 years in practice)
Group practice Poudre Valley Medical Group Llc — 2416 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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