Individual
DR. JACOB ANDREW STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
215 S PARKSIDE DR STE 215, COLORADO SPRINGS, CO 80910-3131
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR.0066643
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029174
KAISER COMMERCIAL NUMBER
CO
Enumeration date
05/01/2018
Last updated
08/21/2021
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