Healthcare Provider Details

I. General information

NPI: 1619155538
Provider Name (Legal Business Name): ALFRED N CARR MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 MOUNTAIN VIEW AVE STE 500
LONGMONT CO
80501-3178
US

IV. Provider business mailing address

2030 MOUNTAIN VIEW AVE STE 500
LONGMONT CO
80501-3178
US

V. Phone/Fax

Practice location:
  • Phone: 303-772-3204
  • Fax: 303-772-7043
Mailing address:
  • Phone: 303-772-3207
  • Fax: 303-772-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number15802
License Number StateCO

VIII. Authorized Official

Name: DR. ALFRED NATHAN CARR
Title or Position: ONWER
Credential: MD
Phone: 303-772-3204