Individual
DR. THEODORE HARRY STATHOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9224 TEDDY LANE, SUITE 200, LONE TREE, CO 80124-6799
(303) 790-1515
(303) 790-1989
Mailing address
9224 TEDDY LN, SUITE 220, LONE TREE, CO 80124-6798
(303) 790-1515
(303) 790-1989
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
33634
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01336346
—
CO
01
—
04018362
GROUP MEDICAID
CO
01
—
109864100
GROUP MEDICAID
WY
05
—
1144265315
—
WY
01
—
1699895755
GROUP NPI
—
01
—
18498
MEDICAL LICENSE
NE
01
—
200293420 A
GROUP MEDICAID
OK
05
—
200295450 A
—
OK
01
—
33634
MEDICAL LICENSE
CO
01
—
8301A
MEDICAL LICENSE
WY
01
—
84127410413
GROUP MEDICAID
NE
Enumeration date
06/19/2006
Last updated
09/28/2010
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