Healthcare Provider Details

I. General information

NPI: 1831191931
Provider Name (Legal Business Name): SCOTT KENNETH STANLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9949 S OSWEGO ST SUITE 200
PARKER CO
80134-3753
US

IV. Provider business mailing address

9949 S OSWEGO ST SUITE 200
PARKER CO
80134-3753
US

V. Phone/Fax

Practice location:
  • Phone: 303-925-4750
  • Fax: 303-925-4751
Mailing address:
  • Phone: 303-925-4750
  • Fax: 303-925-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number42295
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number46601
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: