Healthcare Provider Details

I. General information

NPI: 1710031018
Provider Name (Legal Business Name): KEITH A RANGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 MAIN ST SUITE 100
WINDSOR CO
80550-5559
US

IV. Provider business mailing address

1455 MAIN ST SUITE 100
WINDSOR CO
80550-5559
US

V. Phone/Fax

Practice location:
  • Phone: 970-686-3950
  • Fax: 970-686-3960
Mailing address:
  • Phone: 970-686-3950
  • Fax: 970-686-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26697
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: