Healthcare Provider Details

I. General information

NPI: 1184764771
Provider Name (Legal Business Name): CMD PROFESSIONAL PROVIDER NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 S PIERCE ST SUITE 202
LITTLETON CO
80128-7207
US

IV. Provider business mailing address

7345 S PIERCE ST SUITE 202
LITTLETON CO
80128-7207
US

V. Phone/Fax

Practice location:
  • Phone: 720-837-7593
  • Fax:
Mailing address:
  • Phone: 720-837-7593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. LESLIE COPPIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-837-7593