Provider Demographics
NPI:1104047026
Name:PREMIER ALLERGY & ASTHMA, P.C.
Entity type:Organization
Organization Name:PREMIER ALLERGY & ASTHMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAWEEWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOONTRAKOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-468-8668
Mailing Address - Street 1:19245 E SMOKY HILL RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3122
Mailing Address - Country:US
Mailing Address - Phone:303-468-8668
Mailing Address - Fax:303-468-8669
Practice Address - Street 1:19245 E SMOKY HILL RD UNIT A
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3122
Practice Address - Country:US
Practice Address - Phone:303-468-8668
Practice Address - Fax:303-468-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPR670514OtherANTHEM BLUE SHIELD
COPR670514OtherANTHEM BLUE SHIELD