Provider Demographics
NPI:1063781250
Name:GERIATRIC AND FAMILY MEDICINE
Entity type:Organization
Organization Name:GERIATRIC AND FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-742-0086
Mailing Address - Street 1:2582 S INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2846
Mailing Address - Country:US
Mailing Address - Phone:303-883-1167
Mailing Address - Fax:
Practice Address - Street 1:8015 W ALAMEDA AVE
Practice Address - Street 2:210
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3041
Practice Address - Country:US
Practice Address - Phone:303-742-0086
Practice Address - Fax:303-742-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3336313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility