Provider Demographics
NPI:1215170600
Name:COLORADO CYBERMED, PLLC
Entity type:Organization
Organization Name:COLORADO CYBERMED, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-532-2130
Mailing Address - Street 1:10463 PARK MEADOWS DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5316
Mailing Address - Country:US
Mailing Address - Phone:303-532-2130
Mailing Address - Fax:303-532-2131
Practice Address - Street 1:10463 PARK MEADOWS DR
Practice Address - Street 2:SUITE 114
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5316
Practice Address - Country:US
Practice Address - Phone:303-532-2130
Practice Address - Fax:303-532-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPENDING261QR0200X, 261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation