Provider Demographics
NPI:1063622108
Name:ALPINE UROLOGY, PLLC
Entity type:Organization
Organization Name:ALPINE UROLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-444-9000
Mailing Address - Street 1:4743 ARAPAHOE AVE
Mailing Address - Street 2:SUITE104
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1113
Mailing Address - Country:US
Mailing Address - Phone:303-444-9000
Mailing Address - Fax:303-444-9073
Practice Address - Street 1:4743 ARAPAHOE AVE
Practice Address - Street 2:SUITE104
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1113
Practice Address - Country:US
Practice Address - Phone:303-444-9000
Practice Address - Fax:303-444-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70905843Medicaid