| |
403 S Baldwin St Woodland Park CO 80863-3154 | |
(713) 686-7776 | |
(719) 355-1926 |
Full Name | |
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Speciality | Family Medicine |
Location | 403 S Baldwin St, Woodland Park, Colorado |
Authorized Official Name and Position | Randolph Lee James (PRESIDENT) |
Authorized Official Contact | 7196867776 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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403 S Baldwin St Woodland Park CO 80863-3154 Ph: (713) 686-7776 | 403 S Baldwin St Woodland Park CO 80863-3154 Ph: (713) 686-7776 |
NPI Number | 1346569159 |
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Provider Enumeration Date | 05/19/2010 |
Last Update Date | 01/26/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346569159 | NPI | - | NPPES |
1124011507 | Other | CO | NPI |
71189513 | Other | CO | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 45978 (Colorado) | Primary |
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