Healthcare Provider Details

I. General information

NPI: 1225193279
Provider Name (Legal Business Name): JULIE A STAPLETON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5277 MANHATTAN CIR SUITE 100
BOULDER CO
80303-8201
US

IV. Provider business mailing address

225 W SOUTH BOULDER RD STE 201
LOUISVILLE CO
80027-1194
US

V. Phone/Fax

Practice location:
  • Phone: 303-499-9950
  • Fax:
Mailing address:
  • Phone: 303-665-1007
  • Fax: 303-665-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number30229
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01302298
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: