MEDICARE: RALSTON VALLEY FAMILY PRACTICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1952386260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALSTON VALLEY FAMILY PRACTICE LLC

Provider Business Mailing Address
First Line	:	12001 W 63RD PL
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80004-4034
Country	:	US
Telephone Number	:	303-422-3491
Fax Number	:

Provider Business Practice Location Address
First Line	:	12001 W 63RD PL
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80004-4034
Country	:	US
Telephone Number	:	303-422-3491
Fax Number	:

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	DAVID DOIG
Credential	:
Telephone Number	:	303-422-3491

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	08/22/2020

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