Individual
DR. JAMES ALAN DERRISAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1236 E ELIZABETH ST, SUITE 1, FORT COLLINS, CO 80524-4000
(970) 224-2985
(970) 472-9381
Mailing address
1236 E ELIZABETH ST, SUITE 1, FORT COLLINS, CO 80524-4000
(970) 224-2985
(970) 472-9381
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
26018
NE
207L00000X
Anesthesiology Physician
6553A
WY
207L00000X
Anesthesiology Physician
Primary
DR.0039525
CO
208VP0014X
Interventional Pain Medicine Physician
39525
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04051262
—
CO
05
—
119537900
—
WY
Enumeration date
10/06/2005
Last updated
06/06/2013
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