Provider Demographics
NPI:1609831031
Name:GISH, ERIC (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GISH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 POTOMAC CIR
Mailing Address - Street 2:STE. 265
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6750
Mailing Address - Country:US
Mailing Address - Phone:720-858-6404
Mailing Address - Fax:720-859-7780
Practice Address - Street 1:830 POTOMAC CIR
Practice Address - Street 2:STE. 265
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6750
Practice Address - Country:US
Practice Address - Phone:720-858-6404
Practice Address - Fax:720-859-7780
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41654204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM