Healthcare Provider Details

I. General information

NPI: 1306307665
Provider Name (Legal Business Name): STAPLETON PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 S PEARL ST STE 110
DENVER CO
80210-1538
US

IV. Provider business mailing address

2975 ROSLYN ST UNIT 100
DENVER CO
80238-3326
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-7970
  • Fax: 303-399-7905
Mailing address:
  • Phone: 303-399-7900
  • Fax: 303-799-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY LEMKE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 303-626-7955