| NPI | 1528692092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE BOGUE Credentialing Specialist 719-632-4455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2020-10-25 |