Healthcare Provider Details

I. General information

NPI: 1407805351
Provider Name (Legal Business Name): FRONT RANGE CANCER SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 E HARMONY RD #110
FORT COLLINS CO
80528-8620
US

IV. Provider business mailing address

2315 E HARMONY RD #110
FORT COLLINS CO
80528-8620
US

V. Phone/Fax

Practice location:
  • Phone: 970-212-7600
  • Fax: 970-212-7637
Mailing address:
  • Phone: 970-212-7600
  • Fax: 970-212-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number38494
License Number StateCO

VIII. Authorized Official

Name: JULIUS (GYULA) MEDGYESY
Title or Position: CEO
Credential:
Phone: 970-212-7600