Healthcare Provider Details

I. General information

NPI: 1740667609
Provider Name (Legal Business Name): ROBERT L STOFAC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT LEE STOFAC M.D.

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 STOUT ST
DENVER CO
80205-2827
US

IV. Provider business mailing address

10180 W ASBURY AVE
LAKEWOOD CO
80227-2004
US

V. Phone/Fax

Practice location:
  • Phone: 303-293-2220
  • Fax: 303-293-3977
Mailing address:
  • Phone: 303-229-2422
  • Fax: 303-479-1846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberDRP.0000629
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: