Organization
FRONT RANGE PAIN MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALDON G LANDES DO (OWNER)
(970) 348-0090
Entity
Organization
Contact information
Practice address
5890 W 13TH ST, STE 101, GREELEY, CO 80634-4816
(970) 348-0090
Mailing address
1175 58TH AVE, STE 202, GREELEY, CO 80634-4807
(970) 495-0300
(970) 224-9624
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
41081
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42588529
—
CO
01
—
DD8492
RAILROAD MEDICARE
CO
01
—
FR674273
ANTHEM BCBS
CO
Enumeration date
05/17/2006
Last updated
02/27/2008
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