Provider Demographics
NPI:1841454147
Name:BUCHAN, STACEY L (PA-C)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:BUCHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:JOSIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5693
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5693
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:7780 S BROADWAY STE 350
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:720-638-7500
Practice Address - Fax:720-583-6770
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2567363A00000X
CO2597363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
C809122Medicare PIN
COCO305326Medicare PIN
COC376408Medicare PIN