Provider Demographics
NPI:1609584556
Name:GAYLORD, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 MAROON CREEK RD UNIT 27
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-4303
Mailing Address - Country:US
Mailing Address - Phone:973-477-1886
Mailing Address - Fax:
Practice Address - Street 1:215 S MONARCH ST STE 303
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2917
Practice Address - Country:US
Practice Address - Phone:973-477-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002322171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist