Provider Demographics
NPI:1164592440
Name:ALAN D RAPP MD, PC
Entity Type:Organization
Organization Name:ALAN D RAPP MD, PC
Other - Org Name:PIKES PEAK ADULT MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-442-1715
Mailing Address - Street 1:625 N CASCADE AVE
Mailing Address - Street 2:STE 215
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3254
Mailing Address - Country:US
Mailing Address - Phone:719-442-1715
Mailing Address - Fax:719-442-1547
Practice Address - Street 1:625 N CASCADE AVE
Practice Address - Street 2:STE 215
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-442-1715
Practice Address - Fax:719-442-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43145207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14030004Medicaid
CAP24803Medicare UPIN
CORA74771Medicare ID - Type UnspecifiedALAN RAPP MD
COH31371Medicare UPIN
CO14030004Medicaid
COC522958Medicare ID - Type UnspecifiedDEBRA GRIFFIN NP