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General NPI Number Information
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NPI Number | 1053934711
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Entity Type | Individual
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Provider Name | DRAKE EVAN SISNEROS MD
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Gender | Male
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 473 CASTLE PINES AVE STE 1
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City | JOHNSTOWN
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State | CO
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Zip | 80534-7859
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Country | US
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Telephone | 970-587-7781
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Fax | 970-587-7738
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Provider Business Mailing Address
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Address Line | 6801 W 20TH ST UNIT 101
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City | GREELEY
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State | CO
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Zip | 80634-9640
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Country | US
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Telephone | 970-378-8000
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Fax | 970-378-8035
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0067853
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License Number State | CO
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