Provider Demographics
NPI:1881936219
Name:PARRA, STACY LYNN (MD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:PARRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9094 E MINERAL CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-7201
Mailing Address - Country:US
Mailing Address - Phone:303-779-5437
Mailing Address - Fax:303-689-9628
Practice Address - Street 1:9094 E MINERAL CIR STE 120
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-7201
Practice Address - Country:US
Practice Address - Phone:303-779-5437
Practice Address - Fax:303-689-9628
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CO56751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program