| NPI | 1245864289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE BOGUE Credentialing 719-632-4455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2020-10-26 |