=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770605552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARY W. CAGE MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 06/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 BENCHMARK ROAD SUITE 203
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-845-7872
-----------------------------------------------------
Fax | 970-845-7869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4450 70 BENCHMARK ROAD SUITE 203
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81620-4450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-845-7872
-----------------------------------------------------
Fax | 970-845-7869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. GARY W CAGE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 970-845-7872
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 34904
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------