Provider Demographics
NPI:1124132659
Name:STODDARD, ANDREW PALMER (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PALMER
Last Name:STODDARD
Suffix:
Gender:
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6801 W 20TH STREET
Mailing Address - Street 2:SUITE 101 ATTN SUE
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:970-378-8026
Mailing Address - Fax:
Practice Address - Street 1:6801 W 20TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-378-8000
Practice Address - Fax:970-378-8088
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21477207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1214774Medicaid
CO1214774Medicaid
COCO301577Medicare PIN