Basic Information
| Provider Information | |||||||||
| NPI: | 1932175155 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONROE | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | TRAVIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1899 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195707675 | ||||||||
| FaxNumber: | 7194719314 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 N. NEVADA AVE. | ||||||||
| Address2: | SUITE CC-101 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197765281 | ||||||||
| FaxNumber: | 7197762525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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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 | 2085R0001X | 036-112765 | IL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 044474 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 37986775 | 05 | CO | MEDICAID |