=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881793891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERESKIN AND ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 11/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1850 BASSETT ST 404
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80202-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-273-9598
-----------------------------------------------------
Fax | 303-974-1122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1850 BASSETT ST 404
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80202-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-273-9598
-----------------------------------------------------
Fax | 303-974-1122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. GAYLE FRANKIE BERESKIN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 720-273-9598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 33655
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------