Provider Demographics
NPI:1093896730
Name:STANGEBYE, LARS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LARS
Middle Name:A
Last Name:STANGEBYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 SOUTH NEVADA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5765
Mailing Address - Country:US
Mailing Address - Phone:970-249-7751
Mailing Address - Fax:970-249-5029
Practice Address - Street 1:816 S 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5765
Practice Address - Country:US
Practice Address - Phone:970-240-4311
Practice Address - Fax:970-240-7976
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01326479Medicaid
COCO331018Medicare PIN
COF44263Medicare UPIN