Provider Demographics
NPI:1245686674
Name:CANTRELL, GARY JAMES JR (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:CANTRELL
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 S COLORADO BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1241
Mailing Address - Country:US
Mailing Address - Phone:303-318-3520
Mailing Address - Fax:
Practice Address - Street 1:400 S COLORADO BLVD STE 900
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1241
Practice Address - Country:US
Practice Address - Phone:303-318-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0062666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine