Basic Information
| Provider Information | |||||||||
| NPI: | 1104315019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | XU | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11083 COLORADO BLVD | ||||||||
| Address2: | |||||||||
| City: | FIRESTONE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805045873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038338880 | ||||||||
| FaxNumber: | 3036828007 | ||||||||
| Practice Location | |||||||||
| Address1: | 11083 COLORADO BLVD | ||||||||
| Address2: | |||||||||
| City: | FIRESTONE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805045873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038338880 | ||||||||
| FaxNumber: | 3036828007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2018 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TL.0007372 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | TL.0007372 | CO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | DR.0064282 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.