Provider Demographics
NPI:1720050743
Name:DIPERSIO, CHRISTOPHER RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RICHARD
Last Name:DIPERSIO
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 1:5 STADUIM PLACE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004
Mailing Address - Country:US
Mailing Address - Phone:719-584-3338
Mailing Address - Fax:719-584-3337
Practice Address - Street 1:5 STADIUM PL
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1129
Practice Address - Country:US
Practice Address - Phone:719-584-3338
Practice Address - Fax:719-584-3337
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO531213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37708341Medicaid
COU80375Medicare UPIN
CO37708341Medicaid