Provider Demographics
NPI:1881638070
Name:RHEAUME, GORDON PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:PAUL
Last Name:RHEAUME
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2346
Mailing Address - Country:US
Mailing Address - Phone:719-564-2391
Mailing Address - Fax:719-564-2393
Practice Address - Street 1:1513 MOORE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2346
Practice Address - Country:US
Practice Address - Phone:719-564-2391
Practice Address - Fax:719-564-2393
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0417213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84655241Medicaid
CO01004175Medicaid
COT60247Medicare UPIN
CO56323Medicare PIN