Provider Demographics
NPI:1427450014
Name:EASTERN COLORADO PODIATRY LLC
Entity type:Organization
Organization Name:EASTERN COLORADO PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:DORMISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-525-7211
Mailing Address - Street 1:16350 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FOXFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16350 E ARAPAHOE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FOXFIELD
Practice Address - State:CO
Practice Address - Zip Code:80016-1557
Practice Address - Country:US
Practice Address - Phone:303-525-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO571213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty