Provider Demographics
NPI:1568490910
Name:KLEIN, GARY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2960 N CIRCLE DR
Mailing Address - Street 2:#200
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1163
Mailing Address - Country:US
Mailing Address - Phone:719-634-8891
Mailing Address - Fax:719-634-1897
Practice Address - Street 1:2960 N CIRCLE DR
Practice Address - Street 2:#200
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1163
Practice Address - Country:US
Practice Address - Phone:719-634-8891
Practice Address - Fax:719-634-1897
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO30107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE6318Medicare ID - Type Unspecified
COB68108Medicare UPIN