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General NPI Number Information
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NPI Number | 1184627218
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Entity Type | Individual
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Provider Name | LARRY D KIEFT MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 1136 E STUART ST STE 2100
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City | FORT COLLINS
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State | CO
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Zip | 80525-1197
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Country | US
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Telephone | 970-493-5904
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Fax | 970-493-5973
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Provider Business Mailing Address
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Address Line | 1136 E STUART ST STE 2100
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City | FORT COLLINS
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State | CO
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Zip | 80525-1197
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Country | US
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Telephone | 970-493-5904
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Fax | 970-493-5973
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 21392
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License Number State | CO
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