Provider Demographics
NPI:1225193279
Name:STAPLETON, JULIE A (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:STAPLETON
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 1:225 W SOUTH BOULDER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1194
Mailing Address - Country:US
Mailing Address - Phone:303-665-1007
Mailing Address - Fax:303-665-1089
Practice Address - Street 1:5277 MANHATTAN CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-8201
Practice Address - Country:US
Practice Address - Phone:303-499-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30229208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01302298Medicaid
CO01302298Medicaid
COE65893Medicare UPIN
CO84-1258780OtherTIN