Healthcare Provider Details

I. General information

NPI: 1194016733
Provider Name (Legal Business Name): STEPHEN DALE RELLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2011
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E HARMONY RD SUITE 370
FORT COLLINS CO
80528-3400
US

IV. Provider business mailing address

1300 RIVERSIDE AVE STE 102
FORT COLLINS CO
80524-4351
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-2290
  • Fax: 970-295-0036
Mailing address:
  • Phone: 970-224-1670
  • Fax: 970-495-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51995
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: