Healthcare Provider Details

I. General information

NPI: 1669799243
Provider Name (Legal Business Name): ALEX R DEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 SAWYER DR STE 100
DURANGO CO
81303-3409
US

IV. Provider business mailing address

6938 MEDICAL VIEW LN
ZEPHYRHILLS FL
33542-6602
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-2162
  • Fax:
Mailing address:
  • Phone: 813-780-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME112927
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0059414
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: