Provider Demographics
NPI:1083818686
Name:WARNER, STACEY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LYNN
Last Name:WARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1744
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-6244
Mailing Address - Country:US
Mailing Address - Phone:720-230-6848
Mailing Address - Fax:
Practice Address - Street 1:9777 S YOSEMITE ST STE 210
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-3115
Practice Address - Country:US
Practice Address - Phone:303-708-2943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0017196207L00000X
CO0069660207L00000X
TXM9080207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01446846OtherRR
TX199173906Medicaid
TX8EH631OtherBCBS
TXP01446846OtherRR
TX351275YK6UMedicare PIN