NPI 1457779886 · live from the CMS NPI Registry
Advanced Integrative Medicine
Physician Assistant, Medical in Lone Tree, CO. National Provider Identifier 1457779886, active.
NPI record
| NPI | 1457779886 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Medical 363AM0700X |
| Practice location | 10455 Park Meadows Dr, Ste 102, Lone Tree, CO 80124 |
| Practice phone | 303-708-0246 |
| Enumerated | April 2, 2014 |
| Last updated | April 2, 2014 |
| Authorized official | Randall Snook, Ceo/Medical Director |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant, Medical primary | 363AM0700X | 1285 (CO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.