Healthcare Provider Details

I. General information

NPI: 1215933866
Provider Name (Legal Business Name): CRAIG L PERRINJAQUET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PARK AVE STE 1-A
BRECKENRIDGE CO
80424-8850
US

IV. Provider business mailing address

P.O. BOX 911416
DENVER CO
80291-1416
US

V. Phone/Fax

Practice location:
  • Phone: 970-547-9200
  • Fax: 970-262-2196
Mailing address:
  • Phone: 970-547-9200
  • Fax: 970-262-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26931
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: