Healthcare Provider Details

I. General information

NPI: 1861239543
Provider Name (Legal Business Name): ALPINE MEDICAL GROUP COLORADO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E 104TH AVE STE 115
THORNTON CO
80233-4402
US

IV. Provider business mailing address

999 17TH ST STE 500
DENVER CO
80202-2728
US

V. Phone/Fax

Practice location:
  • Phone: 303-452-2766
  • Fax: 303-252-8694
Mailing address:
  • Phone: 720-728-5170
  • Fax: 720-866-9967

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: KERRY DOYLE
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 720-728-5170