Healthcare Provider Details

I. General information

NPI: 1669482279
Provider Name (Legal Business Name): KHASHAIAR CHAREPOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 W 7TH ST
WRAY CO
80758-1420
US

IV. Provider business mailing address

1017 W 7TH ST
WRAY CO
80758-1420
US

V. Phone/Fax

Practice location:
  • Phone: 970-332-4895
  • Fax: 970-332-4665
Mailing address:
  • Phone: 970-332-4895
  • Fax: 970-332-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number39194
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: