Basic Information
| Provider Information | |||||||||
| NPI: | 1700402039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | DEVON | ||||||||
| MiddleName: | BRENT | ||||||||
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| Credential: | RT(R) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10879 EBONY ST | ||||||||
| Address2: | |||||||||
| City: | FIRESTONE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805045255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703911601 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 WHEELING ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800457211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033998020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2020 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | 1001500 | CO | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist |
No ID Information.