Provider Demographics
NPI:1932175155
Name:MONROE, ALAN TRAVIS (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:TRAVIS
Last Name:MONROE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1899
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901
Mailing Address - Country:US
Mailing Address - Phone:719-570-7675
Mailing Address - Fax:719-471-9314
Practice Address - Street 1:2222 N. NEVADA AVE.
Practice Address - Street 2:SUITE CC-101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-776-5281
Practice Address - Fax:719-776-2525
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1127652085R0001X
CO0444742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37986775Medicaid
ILI31260Medicare UPIN
I31260Medicare UPIN
CO37986775Medicaid