Individual
DR. GRACE C FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13123 E 16TH AVE, AURORA, CO 80045-7106
(720) 777-1234
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
(303) 493-7000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
30740
CO
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
DR.0030740
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01307404
—
CO
Enumeration date
06/14/2005
Last updated
03/17/2018
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