Individual
AMY FITZGERALD PELLOQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4674 SNOW MESA DR, SUITE 100, FORT COLLINS, CO 80528-8615
(970) 482-3712
(970) 266-4190
Mailing address
4674 SNOW MESA DR, SUITE 100, FORT COLLINS, CO 80528-8615
(970) 482-3712
(970) 266-4190
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DR.0056652
CO
207R00000X
Internal Medicine Physician
R-4536
AR
207R00000X
Internal Medicine Physician
R4536
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86330055
—
CO
Enumeration date
06/28/2006
Last updated
09/16/2016
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