Healthcare Provider Details

I. General information

NPI: 1033182811
Provider Name (Legal Business Name): ALONZO CHILDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 N GRANT AVE
LOVELAND CO
80538-8412
US

IV. Provider business mailing address

1120 E ELIZABETH ST F-101
FORT COLLINS CO
80524-4044
US

V. Phone/Fax

Practice location:
  • Phone: 970-593-1177
  • Fax: 970-593-0470
Mailing address:
  • Phone: 970-221-1177
  • Fax: 970-416-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number21678
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: