Healthcare Provider Details

I. General information

NPI: 1144340498
Provider Name (Legal Business Name): RYAN K STALLINGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 S ACADEMY BLVD
COLORADO SPRINGS CO
80916-2406
US

IV. Provider business mailing address

2322 S ACADEMY BLVD
COLORADO SPRINGS CO
80916-2406
US

V. Phone/Fax

Practice location:
  • Phone: 719-390-1727
  • Fax: 719-390-9690
Mailing address:
  • Phone: 719-390-1727
  • Fax: 719-390-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberK3941
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK3941
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46066
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46066
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number46066
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: