Healthcare Provider Details

I. General information

NPI: 1780751578
Provider Name (Legal Business Name): KEVIN E TOWNER CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 FLORENCE AVE
FIRESTONE CO
80520
US

IV. Provider business mailing address

PO BOX 632021
HIGHLANDS RANCH CO
80163-2021
US

V. Phone/Fax

Practice location:
  • Phone: 303-877-8430
  • Fax: 303-471-4456
Mailing address:
  • Phone: 303-847-8422
  • Fax: 303-471-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number90660
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: