Organization
ROCKY MOUNTAIN PEDIATRIC GASTROENTEROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE H. STATHOS MD (AUTHORIZED OFFICIAL, PRESIDENT)
(303) 790-1515
Entity
Organization
Contact information
Practice address
10465 PARK MEADOWS DR STE 201, LONE TREE, CO 80124-5321
(303) 790-1515
(303) 790-1989
Mailing address
10465 PARK MEADOWS DR STE 201, LONE TREE, CO 80124-5321
(303) 790-1515
(303) 790-1989
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04018362
—
CO
Enumeration date
03/30/2007
Last updated
03/28/2019
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