Provider Demographics
NPI:1982874665
Name:ROCKY MOUNTAIN MEDICAL PSYCHIATRY
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN MEDICAL PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:LORIN
Authorized Official - Last Name:ZELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-494-0804
Mailing Address - Street 1:2038 CARIBOU DIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4326
Mailing Address - Country:US
Mailing Address - Phone:970-494-0804
Mailing Address - Fax:970-377-8766
Practice Address - Street 1:2038 CARIBOU DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4338
Practice Address - Country:US
Practice Address - Phone:970-494-0804
Practice Address - Fax:970-377-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR184482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4024Medicare PIN
COB57822Medicare UPIN