MEDICARE: ENDOCRINOLOGY CONSULTANTS OF NORTHERN COLORADO, P.C.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	32251	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DG3569	OTHER	CO	RAILROAD MEDICARE

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	:	1427258920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOCRINOLOGY CONSULTANTS OF NORTHERN COLORADO, P.C.

Provider Business Mailing Address
First Line	:	2121 E HARMONY RD UNIT 300
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3403
Country	:	US
Telephone Number	:	970-224-9102
Fax Number	:	970-224-9112

Provider Business Practice Location Address
First Line	:	1040 E ELIZABETH ST
Second Line	:	UNIT B
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3951
Country	:	US
Telephone Number	:	970-224-3636
Fax Number	:	970-224-3637

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARBARA WIDOM
Credential	:	MD
Telephone Number	:	970-224-3636

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	10/29/2008

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