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General NPI Number Information
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NPI Number | 1902330764
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Entity Type | Organization
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Legal Business Name | SAN JUAN ANESTHESIA LLC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 816 N 2ND ST
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City | MONTROSE
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State | CO
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Zip | 81401-3738
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Country | US
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Telephone | 307-630-3056
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62
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City | MONTROSE
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State | CO
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Zip | 81401
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Country | US
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Telephone | 307-630-3056
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. PAUL WALTER RINNE
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Credential | M.D.
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Telephone | 307-630-3056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0042352
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License Number State | CO
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