Healthcare Provider Details

I. General information

NPI: 1992992051
Provider Name (Legal Business Name): JOHN R SQUIRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 E 3RD AVE SUITE 206
DENVER CO
80206-5110
US

IV. Provider business mailing address

3003 E 3RD AVE SUITE 206
DENVER CO
80206-5110
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-3210
  • Fax:
Mailing address:
  • Phone: 303-321-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number31172
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: