Basic Information
| Provider Information | |||||||||
| NPI: | 1518990647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NG | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8101 E LOWRY BLVD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802307196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033449090 | ||||||||
| FaxNumber: | 3033441922 | ||||||||
| Practice Location | |||||||||
| Address1: | 8101 E LOWRY BLVD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802307196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033449090 | ||||||||
| FaxNumber: | 3033441922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0000X | 635 | CO | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01770785 | 05 | CO | MEDICAID | 0330710001 | 01 | DMERC | OTHER |