Healthcare Provider Details

I. General information

NPI: 1518993757
Provider Name (Legal Business Name): GREGORY UNRUH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HYBROOOK ROAD SOUTH
DIVIDE CO
80814
US

IV. Provider business mailing address

340 PRINTERS PKWY
COLORADO SPRINGS CO
80910-3190
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax: 719-687-4457
Mailing address:
  • Phone: 719-632-5700
  • Fax: 719-344-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44547
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: