Healthcare Provider Details

I. General information

NPI: 1336962679
Provider Name (Legal Business Name): ALPINE MEDICAL GROUP COLORADO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE STE 265
DENVER CO
80210-5075
US

IV. Provider business mailing address

999 17TH ST STE 500
DENVER CO
80202-2728
US

V. Phone/Fax

Practice location:
  • Phone: 303-722-2724
  • Fax:
Mailing address:
  • Phone: 720-728-5170
  • Fax: 720-866-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KERRY DOYLE
Title or Position: SUPERVISOR OF CREDENTIALING
Credential:
Phone: 720-728-5170