Healthcare Provider Details

I. General information

NPI: 1245301449
Provider Name (Legal Business Name): LINDA A COUILLARD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HOSPITAL LOOP
CRAIG CO
81625-8750
US

IV. Provider business mailing address

2650 18TH ST SUITE 100
DENVER CO
80211
US

V. Phone/Fax

Practice location:
  • Phone: 970-824-9411
  • Fax: 970-826-3116
Mailing address:
  • Phone: 720-583-4470
  • Fax: 888-463-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33421
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: