Provider Demographics
NPI:1093792590
Name:ANNEST, STEPHEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:ANNEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4105 E FLORIDA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3641
Mailing Address - Country:US
Mailing Address - Phone:303-539-0736
Mailing Address - Fax:303-539-0737
Practice Address - Street 1:4105 E FLORIDA AVE STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3641
Practice Address - Country:US
Practice Address - Phone:303-539-0736
Practice Address - Fax:303-539-0737
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34233174400000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01342336Medicaid
CO770000990OtherRAILROAD MEDICARE
COB41066Medicare UPIN
COCA1438Medicare PIN