Provider Demographics
NPI:1144265315
Name:STATHOS, THEODORE HARRY (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:HARRY
Last Name:STATHOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9224 TEDDY LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6798
Mailing Address - Country:US
Mailing Address - Phone:303-790-1515
Mailing Address - Fax:303-790-1989
Practice Address - Street 1:9224 TEDDY LANE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6799
Practice Address - Country:US
Practice Address - Phone:303-790-1515
Practice Address - Fax:303-790-1989
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO336342080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04018362OtherGROUP MEDICAID
WY1144265315Medicaid
OK200293420 AOtherGROUP MEDICAID
OK200295450 AMedicaid
CO33634OtherMEDICAL LICENSE
WY109864100OtherGROUP MEDICAID
CO01336346Medicaid
1699895755OtherGROUP NPI
NE18498OtherMEDICAL LICENSE
WY8301AOtherMEDICAL LICENSE
NE84127410413OtherGROUP MEDICAID
CO04018362OtherGROUP MEDICAID