Provider Demographics
NPI:1477669323
Name:GERIATRIC & FAMILY MEDICINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:GERIATRIC & FAMILY MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-742-0086
Mailing Address - Street 1:3885 UPHAM ST.
Mailing Address - Street 2:100
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033
Mailing Address - Country:US
Mailing Address - Phone:303-742-0086
Mailing Address - Fax:303-742-9995
Practice Address - Street 1:3885 UPHAM ST
Practice Address - Street 2:100
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4880
Practice Address - Country:US
Practice Address - Phone:303-742-0086
Practice Address - Fax:720-221-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04230082Medicaid
COC23008Medicare PIN