Healthcare Provider Details

I. General information

NPI: 1063557809
Provider Name (Legal Business Name): KORREY D KLEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 KOKOPELLI BLVD STE 1
FRUITA CO
81521-3308
US

IV. Provider business mailing address

PO BOX 130
FRUITA CO
81521-0130
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-9894
  • Fax: 970-858-1331
Mailing address:
  • Phone: 970-858-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44847
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: