Provider Demographics
NPI:1528124369
Name:WILLARD, JOHN R (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:WILLARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14100 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4028
Mailing Address - Country:US
Mailing Address - Phone:303-699-3190
Mailing Address - Fax:303-699-3189
Practice Address - Street 1:14100 E ARAPAHOE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4028
Practice Address - Country:US
Practice Address - Phone:303-699-3190
Practice Address - Fax:303-699-3189
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2020-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO30373204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01303734Medicaid
COC11062Medicare ID - Type Unspecified
COE95762Medicare UPIN
CO01303734Medicaid