Healthcare Provider Details

I. General information

NPI: 1275979098
Provider Name (Legal Business Name): ASA FOLTMER WARE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 23RD AVE
GREELEY CO
80634-6070
US

IV. Provider business mailing address

1600 23RD AVE
GREELEY CO
80634-6070
US

V. Phone/Fax

Practice location:
  • Phone: 970-356-2424
  • Fax: 970-346-2774
Mailing address:
  • Phone: 970-356-2424
  • Fax: 970-346-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL0004713
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: