Healthcare Provider Details

I. General information

NPI: 1285802199
Provider Name (Legal Business Name): MICHAEL BRIAN ROUNTREE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FAR VIEW DR
ESTES PARK CO
80517-9047
US

IV. Provider business mailing address

350 FAR VIEW DR
ESTES PARK CO
80517-9047
US

V. Phone/Fax

Practice location:
  • Phone: 828-719-0026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD-17756
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: