Provider Demographics
NPI:1235266891
Name:KANARD, ROLY CREEKMORE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLY
Middle Name:CREEKMORE
Last Name:KANARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 JUNIPER TRL
Mailing Address - Street 2:
Mailing Address - City:EL JEBEL
Mailing Address - State:CO
Mailing Address - Zip Code:81623-8651
Mailing Address - Country:US
Mailing Address - Phone:303-921-7659
Mailing Address - Fax:719-530-2055
Practice Address - Street 1:1000 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9627
Practice Address - Country:US
Practice Address - Phone:719-530-2048
Practice Address - Fax:719-530-2055
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42111207R00000X
MEMD23530208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist