Basic Information
| Provider Information | |||||||||
| NPI: | 1689603136 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARRAMONE | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6801 W 20TH ST | ||||||||
| Address2: | STE 201 | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703301090 | ||||||||
| FaxNumber: | 9703302925 | ||||||||
| Practice Location | |||||||||
| Address1: | 799 E HAMPDEN AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037892663 | ||||||||
| FaxNumber: | 3037884871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/31/2007 | ||||||||
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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 | 207X00000X | 43017 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 56532873 | 05 | CO | MEDICAID |