Basic Information
| Provider Information | |||||||||
| NPI: | 1972557072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | XENOS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | SOTEROS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10535 PARK MEADOWS BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036628250 | ||||||||
| FaxNumber: | 3036628249 | ||||||||
| Practice Location | |||||||||
| Address1: | 10535 PARK MEADOWS BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036628250 | ||||||||
| FaxNumber: | 3036628249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | CO30155 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | CO30155 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 09923837 | 05 | CO | MEDICAID | P00201640 | 01 | CO | RR MEDICARE | OTHER |