Healthcare Provider Details

I. General information

NPI: 1003873357
Provider Name (Legal Business Name): PHILIP ADAM STULL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S POTOMAC ST STE 400
AURORA CO
80012
US

IV. Provider business mailing address

1411 S POTOMAC ST STE 400
AURORA CO
80012
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-6060
  • Fax: 303-369-7776
Mailing address:
  • Phone: 303-695-6060
  • Fax: 303-369-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32864
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: