Healthcare Provider Details

I. General information

NPI: 1700272986
Provider Name (Legal Business Name): SPYRIDON A MASTROYANNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 AURORA CT
AURORA CO
80045-2517
US

IV. Provider business mailing address

12631 E 17TH AVE STE B198-5
AURORA CO
80045-2529
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-2066
  • Fax:
Mailing address:
  • Phone: 202-390-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberDR.0068092
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: