Healthcare Provider Details

I. General information

NPI: 1669414272
Provider Name (Legal Business Name): ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S WADSWORTH BLVD STE. D-100
LAKEWOOD CO
80227-5122
US

IV. Provider business mailing address

3333 S WADSWORTH BLVD STE. D-100
LAKEWOOD CO
80227-5122
US

V. Phone/Fax

Practice location:
  • Phone: 303-205-1090
  • Fax: 303-205-1120
Mailing address:
  • Phone: 303-205-1090
  • Fax: 303-205-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER P. CMIL
Title or Position: CFO
Credential:
Phone: 303-205-1090