Individual
JAMES FRED REPPERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1335 PHAY AVE STE A, CANON CITY, CO 81212-2349
(719) 275-4151
(719) 275-3743
Mailing address
1335 PHAY AVE STE A, CANON CITY, CO 81212-2349
(719) 275-4151
(719) 275-3743
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22797
CO
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01227974
—
CO
01
—
RE75491
BLUE CROSS OF COLORADO
CO
Enumeration date
07/08/2005
Last updated
01/11/2022
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