Basic Information
| Provider Information | |||||||||
| NPI: | 1568477420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEHRING | ||||||||
| FirstName: | DEAUN | ||||||||
| MiddleName: | BLOUNT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 MARION STREET | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038306666 | ||||||||
| FaxNumber: | 3038307099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 MARION STREET | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038306666 | ||||||||
| FaxNumber: | 3038307099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 12/04/2013 | ||||||||
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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 | 43826 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 79228046 | 05 | CO | MEDICAID |