Individual
ANTHONY RICHARD DECLUSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1925 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(720) 718-8070
(720) 494-3107
Mailing address
1925 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(720) 718-8070
(720) 494-3107
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
DR.0066615
CO
208D00000X
General Practice Physician
DR.0066615
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000163141
—
CO
Enumeration date
03/28/2018
Last updated
07/06/2023
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