Healthcare Provider Details

I. General information

NPI: 1770550899
Provider Name (Legal Business Name): MELINDA A GEHRS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 W MOUNTAIN VIEW AVE
LONGMONT CO
80501-3128
US

IV. Provider business mailing address

1925 W MOUNTAIN VIEW AVE
LONGMONT CO
80501-3128
US

V. Phone/Fax

Practice location:
  • Phone: 303-485-3323
  • Fax: 303-494-3113
Mailing address:
  • Phone: 303-485-3323
  • Fax: 303-494-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDR.0038089
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDR.0038089
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: