Provider Demographics
NPI:1205560729
Name:STOFAC, GREGORY M
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:STOFAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10255 CARMODY LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2084
Mailing Address - Country:US
Mailing Address - Phone:303-229-5724
Mailing Address - Fax:
Practice Address - Street 1:10255 CARMODY LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-2084
Practice Address - Country:US
Practice Address - Phone:303-229-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCR026001171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty