Provider Demographics
NPI:1831191931
Name:STANLEY, SCOTT KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KENNETH
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9949 S OSWEGO ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3753
Mailing Address - Country:US
Mailing Address - Phone:303-925-4750
Mailing Address - Fax:303-925-4751
Practice Address - Street 1:9949 S OSWEGO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3753
Practice Address - Country:US
Practice Address - Phone:303-925-4750
Practice Address - Fax:303-925-4751
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO42295207X00000X
CO46601207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76472060Medicaid
CO76472060Medicaid
COI04893Medicare UPIN