Staller, Richard Lyle

Staller, Richard Lyle is an sole proprietor health care provider with primary practice located at 30940 Stagecoach Blvd Suite E290, Evergreen CO 80439-7984. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Staller, Richard Lyle can be contacted via phone (303) 674-8153.

Contact Information

Primary practice address
30940 Stagecoach Blvd Suite E290 Evergreen CO 80439-7984
Fax: (303) 674-8303
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 25525 Colorado

Profile Details

NPI number 1962469742
LBN Legal business name Staller, Richard Lyle
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 27th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962469742 NPPES
Colorado MEDICAID 01255256
Colorado Other 38662
Colorado Other 1016326

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