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General NPI Number Information
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NPI Number | 1043766082
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Entity Type | Organization
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Legal Business Name | SPECIALIST TELEMED LLC
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 501 S CHERRY ST STE 1100
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City | DENVER
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State | CO
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Zip | 80246-1323
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Country | US
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Telephone | 800-975-1652
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Fax | 720-588-2562
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Provider Business Mailing Address
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Address Line | 501 S CHERRY ST STE 1100
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City | DENVER
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State | CO
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Zip | 80246-1323
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Country | US
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Telephone | 800-975-1652
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ALEXANDER MASON
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Credential | MD
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Telephone | 404-227-4864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 59555
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License Number State | GA
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