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
Phone: (303) 674-8153
Fax: (303) 674-8303
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962469742 | NPPES |
| Colorado | MEDICAID | 01255256 | |
| Colorado | Other | 38662 | |
| Colorado | Other | 1016326 |
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