Healthcare Provider Details

I. General information

NPI: 1518564368
Provider Name (Legal Business Name): ALLERGY, ASTHMA & IMMUNOLOGY OF THE ROCKIES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 SYLVAN LAKE ROAD SUITE #140
EAGLE CO
81631
US

IV. Provider business mailing address

PO BOX #2601
GLENWOOD SPRINGS CO
81602-2601
US

V. Phone/Fax

Practice location:
  • Phone: 970-947-0600
  • Fax: 978-947-0601
Mailing address:
  • Phone: 970-947-0600
  • Fax: 970-947-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT A. MCDERMOTT
Title or Position: PHYSICIAN OWNER/PRESIDENT
Credential: MD
Phone: 970-947-0600