Healthcare Provider Details

I. General information

NPI: 1114944121
Provider Name (Legal Business Name): SOUTHEAST FAMILY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGEGATE PKWY SUITE 340
LONE TREE CO
80124-5531
US

IV. Provider business mailing address

3464 S WILLOW ST SUITE 376
DENVER CO
80231-4531
US

V. Phone/Fax

Practice location:
  • Phone: 303-706-0400
  • Fax:
Mailing address:
  • Phone: 303-755-2900
  • Fax: 303-755-0404

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: SUSAN PASH-LOHR
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 303-706-0400