1285802967 NPI number — JAMES NEIL MOCKLER M.D.

Table of content: JAMES NEIL MOCKLER M.D. (NPI 1285802967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285802967 NPI number — JAMES NEIL MOCKLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOCKLER
Provider First Name:
JAMES
Provider Middle Name:
NEIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285802967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2930 11TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80620-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-353-9403
Provider Business Mailing Address Fax Number:
970-353-0842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 3RD ST SE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80537-6419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-669-4855
Provider Business Practice Location Address Fax Number:
970-669-7389
Provider Enumeration Date:
02/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  46290 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39370046 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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