Healthcare Provider Details

I. General information

NPI: 1538317169
Provider Name (Legal Business Name): FAMILY AND SPORTS MEDICINE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 ROOD AVE
GRAND JUNCTION CO
81501-2451
US

IV. Provider business mailing address

321 ROOD AVE
GRAND JUNCTION CO
81501-2451
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-8524
  • Fax: 970-263-8427
Mailing address:
  • Phone: 970-243-8524
  • Fax: 970-263-8427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIAN ROBERT GERSHON JR.
Title or Position: OWNER
Credential: DO
Phone: 970-243-8524