Graduated: 1985
NPI: 1568657450
Practice Locations (4)
POUDRE VALLEY MEDICAL GROUP LLC
4404 BARRANCA LN, UNIT 101
CASTLE ROCK, CO 801047419
7207335260
POUDRE VALLEY MEDICAL GROUP LLC
400 W 16TH ST
PUEBLO, CO 810032745
7195844921
PROVIDENCE HEALTH AND SERVICES - OREGON
1111 CRATER LAKE AVE
MEDFORD, OR 975046241
5417325250
PROVIDENCE HEALTH AND SERVICES OREGON
1111 CRATER LAKE AVE
MEDFORD, OR 975046241
5417325545
Source: CMS National Downloadable File, September 2026.