Provider Demographics
NPI:1326816505
Name:SOMERVILLRE, JOHN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:SOMERVILLRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 TWIN SISTERS RD
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-9600
Mailing Address - Country:US
Mailing Address - Phone:720-434-1774
Mailing Address - Fax:
Practice Address - Street 1:1260 TWIN SISTERS RD
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:CO
Practice Address - Zip Code:80466-9600
Practice Address - Country:US
Practice Address - Phone:720-434-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47419207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology