Healthcare Provider Details

I. General information

NPI: 1609814284
Provider Name (Legal Business Name): ROCKY MOUNTAIN FAMILY PRACTICE OF LEADVILLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 US HIGHWAY 24
LEADVILLE CO
80461-3978
US

IV. Provider business mailing address

735 US HIGHWAY 24
LEADVILLE CO
80461-3978
US

V. Phone/Fax

Practice location:
  • Phone: 719-486-0500
  • Fax: 719-486-3966
Mailing address:
  • Phone: 719-486-0500
  • Fax: 719-486-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA P. ZWERDLINGER
Title or Position: OWNER
Credential: M.D.
Phone: 719-486-0500