Basic Information
| Provider Information | |||||||||
| NPI: | 1457626905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOLLET | ||||||||
| FirstName: | ANNA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1407 UNION AVE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018668622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1338 PHAY AVE BLDG D | ||||||||
| Address2: | |||||||||
| City: | CANON CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812122326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192852700 | ||||||||
| FaxNumber: | 7192852975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2012 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR.0065761 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 52684 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 212867001 | 05 | AR | MEDICAID | 06905345 | 05 | MS | MEDICAID | 1457626905 | 05 | KY | MEDICAID | 184959 | 05 | AL | MEDICAID | 1457626905 | 05 | MO | MEDICAID | 003179331A | 05 | GA | MEDICAID | Q016319 | 05 | TN | MEDICAID |