Healthcare Provider Details

I. General information

NPI: 1306225396
Provider Name (Legal Business Name): ERIC MATTHEW GOCHANOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 BLAKE AVE STE 207
GLENWOOD SPRINGS CO
81601-4261
US

IV. Provider business mailing address

PO BOX 2270
GLENWOOD SPRINGS CO
81602-2270
US

V. Phone/Fax

Practice location:
  • Phone: 970-384-7510
  • Fax: 970-384-7511
Mailing address:
  • Phone: 970-384-7510
  • Fax: 970-384-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0071065
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: