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General NPI Number Information
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NPI Number | 1346569159
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Entity Type | Organization
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Legal Business Name | COLORADO FUNCTIONAL MEDICINE
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 403 S BALDWIN ST
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City | WOODLAND PARK
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State | CO
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Zip | 80863-3154
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Country | US
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Telephone | 713-686-7776
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Fax | 719-355-1926
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Provider Business Mailing Address
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Address Line | 403 S BALDWIN ST
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City | WOODLAND PARK
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State | CO
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Zip | 80863-3154
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Country | US
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Telephone | 713-686-7776
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Fax | 719-355-1927
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDOLPH LEE JAMES
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Credential | MD
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Telephone | 719-686-7776
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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 | 45978
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License Number State | CO
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