Provider Demographics
NPI:1376624619
Name:FRONTIER INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:FRONTIER INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAIRD
Authorized Official - Middle Name:P
Authorized Official - Last Name:CAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-776-1532
Mailing Address - Street 1:2030 WEST MOUNTAIN VIEW AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3178
Mailing Address - Country:US
Mailing Address - Phone:303-776-1532
Mailing Address - Fax:303-776-3109
Practice Address - Street 1:2030 WEST MOUNTAIN VIEW AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3178
Practice Address - Country:US
Practice Address - Phone:303-776-1532
Practice Address - Fax:303-776-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D1308Medicare ID - Type Unspecified