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General NPI Number Information
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NPI Number | 1386746881
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Entity Type | Individual
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Provider Name | RODNEY THOMAS GRAVENOR CSA
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Gender | Male
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Dates
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Enumeration Date | 09/04/2006
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 7202 BUCKINGHAM PL
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City | LITTLETON
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State | CO
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Zip | 80130-4169
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Country | US
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Telephone | 303-902-0423
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Fax | 720-221-7796
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Provider Business Mailing Address
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Address Line | 7202 BUCKINGHAM PL
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City | LITTLETON
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State | CO
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Zip | 80130-4169
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Country | US
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Telephone | 303-902-0423
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Fax | 720-221-7796
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA0001088
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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