Healthcare Provider Details

I. General information

NPI: 1538133996
Provider Name (Legal Business Name): WARREN KEITH JAMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S LEMAY AVE SUITE 300
FORT COLLINS CO
80524-3957
US

IV. Provider business mailing address

1325 PARKWOOD CIR
FORT COLLINS CO
80525-1927
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-7442
  • Fax: 970-493-2990
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28997
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: