Organization
LOMA VISTA SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENT E GAY MD (PRESIDENT)
(719) 384-8181
Entity
Organization
Contact information
Practice address
2201 SAN JUAN AVE, LA JUNTA, CO 81050-3323
(719) 384-8181
(719) 384-4872
Mailing address
2201 SAN JUAN AVE, LA JUNTA, CO 81050-3323
(719) 384-8181
(719) 384-4872
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
21632
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04108080
—
CO
Enumeration date
10/11/2005
Last updated
08/22/2020
Update your record
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