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General NPI Number Information
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NPI Number | 1710941158
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STATES PATHOLOGY PC
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 2222 N NEVADA AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907
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Country | US
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Telephone | 719-776-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 744127
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City | DALLAS
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State | TX
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Zip | 75374
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Country | US
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Telephone | 719-776-5816
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Fax | 719-776-2108
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS WILLIAM FRANQUEMONT
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Credential | MD
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Telephone | 719-776-5816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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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 | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZM0300X
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Taxonomy Name | Medical Microbiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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