Canon City OBGYN PC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

30880 Issued in CO

Legal business name

CANON CITY OBGYN PC

Practice address

1335 Phay Ave
Ste C
Canon City, CO 81212-2334

Phone

(719) 275-5261

Fax

(719) 275-1687

NPI assigned

Feb 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Pelham Porter Staples III, M.D.

Title

Owner President

Phone

(719) 275-5261

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376686691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 PHAY AVE",
            "address_2": "STE C",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122334",
            "telephone_number": "719-275-5261",
            "fax_number": "719-275-1687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 PHAY AVE",
            "address_2": "STE C",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122334",
            "telephone_number": "719-275-5261",
            "fax_number": "719-275-1687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANON CITY OBGYN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAPLES",
        "authorized_official_first_name": "PELHAM",
        "authorized_official_middle_name": "PORTER",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "719-275-5261",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CO",
            "license": "30880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR STAPLES NPI",
            "identifier": "1679521322",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01308808",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Canon City, CO
• Providers in Canon City, CO by specialty
• Obstetrics & Gynecology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.