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Organization
LONGS PEAK FAMILY PRACTICE, PC
Active
Organization
LONGS PEAK FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN I ROACH M.D. (OFFICER)
(303) 772-5578
Entity
Organization
Contact information
Practice address
1309 SUNSET ST, LONGMONT, CO 80501-3215
(303) 772-5578
(303) 772-8207
Mailing address
1309 SUNSET ST, LONGMONT, CO 80501-3215
(303) 772-5578
(303) 772-8207
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
NULL
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
08/12/2006
Last updated
02/08/2008
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