MEDICARE: DR. GARY JAMES CANTRELL JR. D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DR.0062666	CO

General Provider Information

NPI Number	:	1245686674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY JAMES CANTRELL JR. D.O

Provider Business Mailing Address
First Line	:	400 S COLORADO BLVD STE 900
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80246-1241
Country	:	US
Telephone Number	:	303-318-3520
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S COLORADO BLVD STE 900
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80246-1241
Country	:	US
Telephone Number	:	303-318-3520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2016
Last Update Date	:	04/14/2022

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