Healthcare Provider Details

I. General information

NPI: 1104047026
Provider Name (Legal Business Name): PREMIER ALLERGY & ASTHMA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/05/2020
Certification Date: 09/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19245 E SMOKY HILL RD UNIT A
CENTENNIAL CO
80015-3122
US

IV. Provider business mailing address

19245 E SMOKY HILL RD UNIT A
CENTENNIAL CO
80015-3122
US

V. Phone/Fax

Practice location:
  • Phone: 303-468-8668
  • Fax: 303-468-8669
Mailing address:
  • Phone: 303-468-8668
  • Fax: 303-468-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAWEEWAN HOONTRAKOON
Title or Position: OWNER
Credential:
Phone: 303-468-8668