Provider Demographics
NPI:1376580571
Name:HUFFMAN, STACY L (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13650 E MISSISSIPPI AVE
Mailing Address - Street 2:100-B
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3561
Mailing Address - Country:US
Mailing Address - Phone:303-695-1338
Mailing Address - Fax:303-695-8814
Practice Address - Street 1:13650 E MISSISSIPPI AVE
Practice Address - Street 2:100-B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3561
Practice Address - Country:US
Practice Address - Phone:303-695-1338
Practice Address - Fax:303-695-8814
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34236589Medicaid
CO800799Medicare ID - Type Unspecified
COG90648Medicare UPIN