Provider Demographics
NPI:1538252580
Name:CHILDS, STACY JAY (MD)
Entity type:Individual
Prefix:MR
First Name:STACY
Middle Name:JAY
Last Name:CHILDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 880310
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80488-0310
Mailing Address - Country:US
Mailing Address - Phone:970-871-9710
Mailing Address - Fax:970-871-9709
Practice Address - Street 1:501 ANGLERS DR
Practice Address - Street 2:STE 202
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8840
Practice Address - Country:US
Practice Address - Phone:970-871-9710
Practice Address - Fax:970-871-9709
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-04-25
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Provider Licenses
StateLicense IDTaxonomies
CO34579208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01345792Medicaid
C76428Medicare UPIN
COC527238Medicare PIN