Basic Information
| Provider Information | |||||||||
| NPI: | 1730210733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMMON | ||||||||
| FirstName: | STEFEN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1241 W MINERAL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801205685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037590854 | ||||||||
| FaxNumber: | 3037590864 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 S BROADWAY | ||||||||
| Address2: | LITTLETON ADVENTIST HOSPITAL, EMERGENCY DEPT. | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037785666 | ||||||||
| FaxNumber: | 3037785787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | CDRH.0045573 | CO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 58357 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 18674 | NV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MC-0362 | ID | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 45573 | CO | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00442365 | 01 | CO | RR MEDICARE | OTHER | 45607753 | 05 | CO | MEDICAID |