Organization
YOUR FAMILY MEDICAL HOME,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DAVID ZAITZ (ADMINISTRATOR)
(925) 597-0121
Entity
Organization
Contact information
Practice address
435 N PARK AV, SUITE 2A, BRECKENRIDGE, CO 80424
(970) 238-7070
(970) 453-5332
Mailing address
PO BOX 5620, BRECKENRIDGE, CO 80424-5620
(970) 238-7070
(970) 423-5332
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31975
CO
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01319755
—
CO
05
—
81751737
—
CO
Enumeration date
03/10/2010
Last updated
08/17/2021
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