Provider Demographics
NPI:1790763662
Name:GONYON, DENIS L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:L
Last Name:GONYON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4450 UNION ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-2864
Mailing Address - Country:US
Mailing Address - Phone:970-624-7979
Mailing Address - Fax:970-624-7980
Practice Address - Street 1:4450 UNION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-2864
Practice Address - Country:US
Practice Address - Phone:970-624-7979
Practice Address - Fax:970-624-7980
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2015-01-28
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Provider Licenses
StateLicense IDTaxonomies
CO43327208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12683027Medicaid
COP00711616OtherRR MEDICARE
COP00711616OtherRR MEDICARE
COC801671Medicare PIN