Provider Demographics
NPI:1326310236
Name:OB/GYN SPECIALISTS OF THE ROCKY MOUNTAINS, PROF LLC
Entity Type:Organization
Organization Name:OB/GYN SPECIALISTS OF THE ROCKY MOUNTAINS, PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-240-9898
Mailing Address - Street 1:400 N PARK AVE UNIT 10B
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-8963
Mailing Address - Country:US
Mailing Address - Phone:970-453-2320
Mailing Address - Fax:970-453-6384
Practice Address - Street 1:435 PARK AVENUE
Practice Address - Street 2:SUITE 2A
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-7399
Practice Address - Country:US
Practice Address - Phone:970-453-2320
Practice Address - Fax:970-453-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47511207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty