Provider Demographics
NPI:1518688498
Name:DEEMIE, ROBERT F SR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:DEEMIE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 KODIAK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1807
Mailing Address - Country:US
Mailing Address - Phone:719-344-9229
Mailing Address - Fax:
Practice Address - Street 1:1626 KODIAK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-1807
Practice Address - Country:US
Practice Address - Phone:719-344-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO920547457172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty