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Individual

HENRY RAY LANDSGAARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1024 S LEMAY AVE, FORT COLLINS, CO 80524-3929
(970) 495-7000
(303) 306-7753
Mailing address
PO BOX 912215, DENVER, CO 80291-2215
(303) 306-7783
(303) 306-7753

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5101011929
MI
207P00000X
Emergency Medicine Physician
Primary
DR.0055268
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3332953
MI
05
3339927
MI
05
3417756
MI
05
95937072
CO
01
HL011929
BLUE CROSS BLUE SHIELD
01
P00065018
RAILROAD MEDICARE PIN
MI
Enumeration date
11/23/2005
Last updated
06/29/2015
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