Basic Information
| Provider Information | |||||||||
| NPI: | 1275522526 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COONROD | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | ALINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 23RD AVE | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806346070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703562424 | ||||||||
| FaxNumber: | 9703462774 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 23RD AVE | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806346070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703562424 | ||||||||
| FaxNumber: | 9703462774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR33909 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01339092 | 05 | CO | MEDICAID |