Provider Demographics
NPI:1336126408
Name:PERGREM, CHRISTOPHER W (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:PERGREM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3033 S PARKER RD
Mailing Address - Street 2:STE 800
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2910
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:3033 S PARKER RD
Practice Address - Street 2:STE 800
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2910
Practice Address - Country:US
Practice Address - Phone:303-306-7783
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36395207P00000X
CO39044207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73105031Medicaid
COE50227Medicare ID - Type Unspecified
COH03733Medicare UPIN