Facts
- Status
- A
- Credential
- DO
- Type
- Individual
- Enumeration date
- 2012-06-11
- Last updated
- 2021-05-20
Specialties
Licenses
- License KS
- 9407845
Location
- Practice location
- 2400 EDISEN ST.
- City
- BRUSH CO
- Postal code
- 80723
- Phone
- 970-842-6262
Medicare
- PECOS
- A PECOS enrollment row matches 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.