| NPI | 1245392612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY J CLARK Credentialing Coordinator 970-254-2642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| 208000000X Pediatrics | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2022-01-04 |