Provider Demographics
NPI:1386657559
Name:STALLWORTH, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:STALLWORTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10099 RIDGEGATE PKWY
Mailing Address - Street 2:370
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5531
Mailing Address - Country:US
Mailing Address - Phone:303-795-3110
Mailing Address - Fax:303-795-6992
Practice Address - Street 1:10099 RIDGEGATE PKWY
Practice Address - Street 2:370
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5531
Practice Address - Country:US
Practice Address - Phone:303-795-3110
Practice Address - Fax:303-795-6992
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO25137207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01251370Medicaid
COC364468Medicare ID - Type Unspecified
CO01251370Medicaid