Healthcare Provider Details

I. General information

NPI: 1629030689
Provider Name (Legal Business Name): PEDIATRICS 5280 PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9094 E MINERAL AVE SUITE 120
CENTENNIAL CO
80112-7200
US

IV. Provider business mailing address

9094 E MINERAL AVE SUITE 120
CENTENNIAL CO
80112-7200
US

V. Phone/Fax

Practice location:
  • Phone: 303-779-5437
  • Fax: 303-689-9628
Mailing address:
  • Phone: 303-779-5437
  • Fax: 303-689-9628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HOLBROOK STAPP
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 303-779-5437