Basic Information
| Provider Information | |||||||||
| NPI: | 1124193453 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEGRI | ||||||||
| FirstName: | DAMON | ||||||||
| MiddleName: | J | ||||||||
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| OtherLastName: | NEGRI | ||||||||
| OtherFirstName: | DAMON | ||||||||
| OtherMiddleName: | J | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 173894 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802173894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033067783 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Practice Location | |||||||||
| Address1: | 4747 ARAPAHOE AVENUE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803031133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033067783 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 11/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 8321 | NH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DR.0025479 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0194671 | 05 | MA | MEDICAID | 275270099 | 05 | ME | MEDICAID | 30007778 | 05 | NH | MEDICAID | 930050636 | 01 | NH | RAILROAD | OTHER | 0105112Y0NH07 | 01 | NH | ANTHEM | OTHER | 0105112Y0NH08 | 01 | NH | BCBS OF NH | OTHER |