MEDICARE: MS. ANNE M STAVROS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363AM0700X	Medical Physician Assistant	PA0005582	CO
3	363A00000X	Physician Assistant	5582	CO
4	363AM0700X	Medical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA.0005582	OTHER	CO	DEPT OF REGULATORY AGENCIES DORA

General Provider Information

NPI Number	:	1518319094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE M STAVROS PA-C

Provider Business Mailing Address
First Line	:	2601 MIDPOINT DR STE 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4448
Country	:	US
Telephone Number	:	970-980-2425
Fax Number	:	970-980-2430

Provider Business Practice Location Address
First Line	:	2601 MIDPOINT DR STE 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4448
Country	:	US
Telephone Number	:	970-980-2425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	03/09/2026

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