Individual
ENRICO JOHN VERSACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
310 COUNTY ROAD 14, RIO GRANDE HOSPITAL, DEL NORTE, CO 81132-8719
(719) 657-4102
(719) 657-4106
Mailing address
310 COUNTY ROAD 14, RIO GRANDE HOSPITAL, DEL NORTE, CO 81132-8719
(719) 657-4102
(719) 657-4106
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0053518
CO
207R00000X
Internal Medicine Physician
60167506
WA
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
60167506
WA
208M00000X
Hospitalist Physician
11019
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47105348
—
CO
01
—
53518
CO LICENSE
CO
Enumeration date
02/23/2006
Last updated
03/27/2017
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