Basic Information
| Provider Information | |||||||||
| NPI: | 1164852190 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCKY MOUNTAIN PAIN SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16830 NORTHGATE DRIVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038057246 | ||||||||
| FaxNumber: | 3038407159 | ||||||||
| Practice Location | |||||||||
| Address1: | 16830 NORTHGATE DR | ||||||||
| Address2: | STE 130 | ||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038057246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2013 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | GABRIEL | ||||||||
| AuthorizedOfficialFirstName: | SHAWN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN AUTH. OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3038057246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NN0400X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Neurology | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.