Organization
PEDIATRIC ASSOCIATES OF FORT COLLINS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD R BOOTH MD (OWNER)
(970) 484-4871
Entity
Organization
Contact information
Practice address
2001 S SHIELDS ST, BLDG G, FORT COLLINS, CO 80526-1827
(970) 484-4871
(970) 482-4927
Mailing address
2001 SOUTH SHIELDS, BLDG G, FORT COLLINS, CO 80526
(970) 484-4871
(970) 482-4927
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4355467
AETNA
CO
01
—
644929
ANTHEM
CO
05
—
79523765
—
CO
Enumeration date
04/03/2007
Last updated
08/22/2020
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