Provider Demographics
NPI:1104808690
Name:SANGRE DE CRISTO INTERNAL MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:SANGRE DE CRISTO INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:DUFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-542-3100
Mailing Address - Street 1:1600 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2757
Mailing Address - Country:US
Mailing Address - Phone:719-542-3100
Mailing Address - Fax:
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2757
Practice Address - Country:US
Practice Address - Phone:719-542-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803655Medicare ID - Type Unspecified