Healthcare Provider Details

I. General information

NPI: 1336152719
Provider Name (Legal Business Name): JOHN KEVIN STANTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 REDTAIL HAWK DR
ESTES PARK CO
80517-9780
US

IV. Provider business mailing address

203 S ROLLIE AVE
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 970-586-9230
  • Fax: 970-586-0292
Mailing address:
  • Phone: 303-286-4560
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0029086
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: