Basic Information
| Provider Information | |||||||||
| NPI: | 1841298460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANTER | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3555 LUTHERAN PKWY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039401867 | ||||||||
| FaxNumber: | 3039401894 | ||||||||
| Practice Location | |||||||||
| Address1: | 3555 LUTHERAN PKWY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039401867 | ||||||||
| FaxNumber: | 3039401894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 03/30/2010 | ||||||||
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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 | 207V00000X | 33050 | CO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01330505 | 05 | CO | MEDICAID | 160044760 | 01 | CO | RAIL ROAD MEDICARE | OTHER | 04012365 | 05 | CO | MEDICAID |