Provider Demographics
NPI:1063482982
Name:GUNSTREAM, STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:GUNSTREAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-624-4443
Mailing Address - Fax:970-490-4175
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:STE 300
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-224-9102
Practice Address - Fax:970-224-9112
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21719207R00000X, 207RC0200X, 207RP1001X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1063482982Medicaid
CO290007465OtherRAILROAD MEDICARE
CO290007465OtherRAILROAD MEDICARE
CO1063482982Medicaid