Provider Demographics
NPI:1659396984
Name:TOTH, STEPHEN W (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:TOTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:W
Other - Last Name:TOTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:151 W LAKE ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4124
Mailing Address - Country:US
Mailing Address - Phone:970-495-8450
Mailing Address - Fax:970-297-6599
Practice Address - Street 1:1011 39TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2504
Practice Address - Country:US
Practice Address - Phone:970-351-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2035363AS0400X
COPA.0002035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB5052Medicaid
Q36217Medicare UPIN
C800999Medicare PIN