Provider Demographics
NPI:1881654150
Name:HOLSWORTH, RALPH EDWARD JR (DO)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EDWARD
Last Name:HOLSWORTH
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15300 QUANDARY PEAK RD
Mailing Address - Street 2:
Mailing Address - City:PINE
Mailing Address - State:CO
Mailing Address - Zip Code:80470-9135
Mailing Address - Country:US
Mailing Address - Phone:970-560-0011
Mailing Address - Fax:
Practice Address - Street 1:373 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:CO
Practice Address - Zip Code:81073-1622
Practice Address - Country:US
Practice Address - Phone:719-523-6628
Practice Address - Fax:719-523-4290
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37599207Q00000X
WAOP60185754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04837011Medicaid
CO04837011Medicaid
CO301062Medicare PIN
WAG8902635Medicare PIN
COH31833Medicare UPIN