| Colorado Provider Network Llc | |
|
1435 Garrison St Ste 110 Lakewood CO 80215-4748 | |
| (720) 241-3765 | |
| Not Available |
| Full Name | Colorado Provider Network Llc |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 1435 Garrison St Ste 110, Lakewood, Colorado |
| Authorized Official Name and Position | John Edward Marquez (OWNER) |
| Authorized Official Contact | 7202413765 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Colorado Provider Network Llc Po Box 12375 Denver CO 80212-0375 Ph: (970) 664-2497 | Colorado Provider Network Llc 1435 Garrison St Ste 110 Lakewood CO 80215-4748 Ph: (720) 241-3765 |
| NPI Number | 1114602596 |
|---|---|
| Provider Enumeration Date | 06/21/2023 |
| Last Update Date | 06/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114602596 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
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