Healthcare Provider Details

I. General information

NPI: 1407821960
Provider Name (Legal Business Name): ERIN C PRENGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 E. GEDDES AVE SUITE 200 ATTN CREDENTIALING
ENGLEWOOD CO
80112
US

IV. Provider business mailing address

10700 E. GEDDES AVE SUITE 200 ATTN CREDENTIALING
ENGLEWOOD CO
80112
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-9190
  • Fax: 303-761-6278
Mailing address:
  • Phone: 303-761-9190
  • Fax: 303-761-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number3484
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3484
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number32827
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: