Provider Demographics
NPI:1912022393
Name:TENTORI, ERICSON B (DO)
Entity Type:Individual
Prefix:DR
First Name:ERICSON
Middle Name:B
Last Name:TENTORI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:B
Other - Last Name:TENTORI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2650 S COLUMBINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-6442
Mailing Address - Country:US
Mailing Address - Phone:970-433-6837
Mailing Address - Fax:
Practice Address - Street 1:2650 S COLUMBINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-6442
Practice Address - Country:US
Practice Address - Phone:970-433-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO338752083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811604OtherMEDICARE GROUP NUMBER
COC300632Medicare PIN