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General NPI Number Information
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NPI Number | 1285632893
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Entity Type | Individual
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Provider Name | JAMES FRED REPPERT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 1335 PHAY AVE STE A
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City | CANON CITY
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State | CO
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Zip | 81212-2349
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Country | US
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Telephone | 719-275-4151
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Fax | 719-275-3743
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Provider Business Mailing Address
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Address Line | 1335 PHAY AVE STE A
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City | CANON CITY
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State | CO
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Zip | 81212-2349
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Country | US
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Telephone | 719-275-4151
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Fax | 719-275-3743
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 22797
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License Number State | CO
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