Individual
DR. EDWIN DALE RISENHOOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2923 GINNALA DR, LOVELAND, CO 80538-2702
(970) 820-5000
(970) 820-5061
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
(970) 820-5000
(970) 820-5061
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36666
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01366665
—
CO
01
—
841328898006
ROCKY MOUNTAIN HEALTH PLA
—
01
—
84132889808
PACIFICARE
—
01
—
84132889809
SECURE HORIZONS
—
Enumeration date
05/08/2006
Last updated
02/20/2023
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