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General NPI Number Information
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NPI Number | 1548620875
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Entity Type | Organization
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Legal Business Name | MODERN ALLERGY
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 10446 STONEWILLOW DR
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City | PARKER
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State | CO
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Zip | 80134-2503
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Country | US
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Telephone | 303-995-0400
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Fax | 720-292-1821
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Provider Business Mailing Address
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Address Line | 10446 STONEWILLOW DR
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City | PARKER
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State | CO
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Zip | 80134-2503
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Country | US
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Telephone | 303-995-0400
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Fax | 720-292-1821
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHRISTOPHER WEBBER
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Credential | M.D.
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Telephone | 303-995-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | DR49051
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207KI0005X
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Taxonomy Name | Clinical & Laboratory Immunology (Allergy & Immunology) Physician
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License Number | DR49051
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | DR49051
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License Number State | CO
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