Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2008-04-02
- Last updated
- 2008-04-02
Specialties
Licenses
- License CO
- 175234
Location
- Practice location
- 1650 COCHRANE CIR, BUILDING 2059, ATTN:MCXE-PMD-PHN-HA
- City
- FT CARSON CO
- Postal code
- 809134603
- Phone
- 719-524-0727
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.