# CANON CITY OBGYN PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376686691
- **Authorized official:** DR. PELHAM PORTER STAPLES III M.D. (OWNER PRESIDENT)
- **Authorized official phone:** (719) 275-5261

## Contact information

- **Practice address:** 1335 PHAY AVE, STE C, CANON CITY, CO 81212-2334
- **Practice address phone:** (719) 275-5261
- **Practice address fax:** (719) 275-1687
- **Mailing address:** 1335 PHAY AVE, STE C, CANON CITY, CO 81212-2334
- **Mailing address phone:** (719) 275-5261
- **Mailing address fax:** (719) 275-1687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 30880 | CO | Yes |

## Other

- **Enumeration date:** 02/15/2007
- **Last updated:** 08/22/2020