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STACY MARIE ATHERTON DPM
Foot & Ankle Surgery >> Podiatrist >> Podiatric Medicine & Surgery Service ProvidersRegistrant NPI Number: 1891957023
Individual Registrant: STACY MARIE ATHERTON DPM
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
1305 SUMNER ST STE 200 LONGMONT, CO 80501-3271 US
Tel: 303-772-3232 Fax: --
Tel: 303-772-3232 Fax: --
Contact information for business:
1931 65TH AVE #A GREELEY, CO 80634-7945 US
Tel: 970-351-0900 Fax: --
Tel: 970-351-0900 Fax: --
Registration Information:
NPI: 1891957023
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 213ES0103X | Podiatric Medicine & Surgery Service Providers Podiatrist Foot & Ankle Surgery | OR | DP00437 |
| Y | 213ES0103X | Podiatric Medicine & Surgery Service Providers Podiatrist | CO | 703 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 78927528 | CO | 05 |
