Provider Demographics
NPI:1912012733
Name:PAGE, BILLY JOE (DO)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JOE
Last Name:PAGE
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 1:2352 MEADOWS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8419
Mailing Address - Country:US
Mailing Address - Phone:720-455-3775
Mailing Address - Fax:720-455-3776
Practice Address - Street 1:2352 MEADOWS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109
Practice Address - Country:US
Practice Address - Phone:720-455-3775
Practice Address - Fax:720-455-3776
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007290207XS0106X
CODR.0056832207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI408827811Medicaid
MI0H11016OtherBCBSM GROUP PIN
MI0H11016OtherBCBSM GROUP PIN
MI0M28350003Medicare ID - Type Unspecified
MIMI1993001Medicare PIN