Provider Demographics
NPI:1972683035
Name:FRONT RANGE ENDOCRINOLOGY PC
Entity Type:Organization
Organization Name:FRONT RANGE ENDOCRINOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:BOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-359-1223
Mailing Address - Street 1:5753 WINDRIDGE PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-1423
Mailing Address - Country:US
Mailing Address - Phone:719-495-4120
Mailing Address - Fax:
Practice Address - Street 1:1625 MEDICAL CENTER PT
Practice Address - Street 2:SUITE 220
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8731
Practice Address - Country:US
Practice Address - Phone:719-630-3276
Practice Address - Fax:719-635-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42508261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12251321Medicaid
1750370003OtherINDIVIDUAL NPI NUMBER
CO12251321Medicaid
1750370003OtherINDIVIDUAL NPI NUMBER