Basic Information
| Provider Information | |||||||||
| NPI: | 1578601761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REA | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | GRANT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8101 E LOWRY BLVD | ||||||||
| Address2: | STE 120 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802307195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033776825 | ||||||||
| FaxNumber: | 3037800787 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 SHERMAN ST | ||||||||
| Address2: | STE 510 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802034400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033776825 | ||||||||
| FaxNumber: | 3037800787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 46334 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | T4825 | 01 | MD | PROVIDER ID | OTHER | 0153261 | 05 | CO | MEDICAID |