Provider Demographics
NPI:1659868792
Name:GUPTON, KEVIN S
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:GUPTON
Suffix:
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 1:1270 ALBION RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6636
Mailing Address - Country:US
Mailing Address - Phone:303-585-0967
Mailing Address - Fax:
Practice Address - Street 1:1270 ALBION RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6636
Practice Address - Country:US
Practice Address - Phone:303-585-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty