MEDICARE: RITA ALINE COONROD MD

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	33909	CO
2	207Q00000X	Family Medicine Physician	DR.0033909	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275522526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA ALINE COONROD MD

Provider Business Mailing Address
First Line	:	777 BANNOCK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4597
Country	:	US
Telephone Number	:	303-436-4949
Fax Number	:	303-602-4064

Provider Business Practice Location Address
First Line	:	145 PARSENN RD
Second Line	:
City	:	WINTER PARK
State	:	CO
Zip	:	80482-5133
Country	:	US
Telephone Number	:	970-726-4299
Fax Number	:	970-726-4322

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	12/11/2024

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