Provider Demographics
NPI:1811927510
Name:WORLEY, BOB STANTON (MD)
Entity type:Individual
Prefix:DR
First Name:BOB
Middle Name:STANTON
Last Name:WORLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7445
Mailing Address - Country:US
Mailing Address - Phone:303-949-1250
Mailing Address - Fax:
Practice Address - Street 1:6161 S SYRACUSE WAY
Practice Address - Street 2:310
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4707
Practice Address - Country:US
Practice Address - Phone:303-220-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01243120Medicaid
CO325518Medicare ID - Type Unspecified
CO01243120Medicaid