Provider Demographics
NPI:1376581694
Name:DERY, ROBERT ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEXIS
Last Name:DERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 E RD
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:CO
Mailing Address - Zip Code:81526-9558
Mailing Address - Country:US
Mailing Address - Phone:970-464-9019
Mailing Address - Fax:
Practice Address - Street 1:DEPT #0861
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80256-0001
Practice Address - Country:US
Practice Address - Phone:866-898-7136
Practice Address - Fax:616-975-9824
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43730207PE0004X
CAA80430207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00278508OtherRAILROAD
UTT0423Medicaid
CO59626861Medicaid
CO59626861Medicaid
COP00278508OtherRAILROAD