Basic Information
| Provider Information | |||||||||
| NPI: | 1609845676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUSEY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 150 | ||||||||
| Address2: | |||||||||
| City: | HOLLY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810470150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195370712 | ||||||||
| FaxNumber: | 7195376284 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 PEAK ONE DRIVE | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195370712 | ||||||||
| FaxNumber: | 7195376284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207L00000X | G36810 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 27718 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00G368100 | 05 | CA | MEDICAID |