Organization
OUR LADY OF GRACE MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLOS F VERA MD (CEO)
(303) 531-5181
Entity
Organization
Contact information
Practice address
992 W 104TH AVE, NORTHGLENN, CO 80234-3801
(303) 531-5181
(303) 531-5185
Mailing address
PO BOX 350968, WESTMINSTER, CO 80035-0968
(303) 531-5181
(303) 531-5185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92600786
—
CO
Enumeration date
03/14/2007
Last updated
03/04/2008
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