Healthcare Provider Details

I. General information

NPI: 1497076681
Provider Name (Legal Business Name): FIRSTDOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 MEADE ST
DENVER CO
80204-1552
US

IV. Provider business mailing address

PO BOX 479
ERIE CO
80516-0479
US

V. Phone/Fax

Practice location:
  • Phone: 970-391-4303
  • Fax:
Mailing address:
  • Phone: 970-391-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES KOPEL
Title or Position: OWNER
Credential: MD
Phone: 970-391-4303