Individual
DAVID IMMANUEL FREEMAN FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
114 COTTONWOOD CREEK RD APT A1, DURANGO, CO 81301-6163
(970) 749-9113
Mailing address
7887 E BELLEVIEW AVE STE 1100, ENGLEWOOD, CO 80111-6097
(970) 749-9113
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2021-0009
NM
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
07/02/2020
Last updated
11/08/2024
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