Basic Information
| Provider Information | |||||||||
| NPI: | 1174587109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HO | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 460041 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802460041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037222724 | ||||||||
| FaxNumber: | 3037223121 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 E HARVARD AVE | ||||||||
| Address2: | SUITE 455 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802105073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037222724 | ||||||||
| FaxNumber: | 3037223121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37440 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 78501571 | 05 | CO | MEDICAID |