Healthcare Provider Details

I. General information

NPI: 1740668425
Provider Name (Legal Business Name): JOHN ECHTERMEYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 BANNOCK ST
DENVER CO
80204-5126
US

IV. Provider business mailing address

456 BANNOCK ST
DENVER CO
80204-5126
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: