Declusin, Anthony Richard

Declusin, Anthony Richard is an individual health care provider with primary practice located at 1925 Mountain View Ave , Longmont CO 80501-3128. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neurology is his primary health care specialty. Declusin, Anthony Richard can be contacted via phone (720) 718-8070.

Contact Information

Primary practice address
1925 Mountain View Ave Longmont CO 80501-3128
Phone: (720) 718-8070
Fax: (720) 494-3107
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X DR.0066615 Colorado
Allopathic & Osteopathic Physicians / Neurology 2084N0400X DR.0066615 Colorado

Profile Details

NPI number 1669977997
LBN Legal business name Declusin, Anthony Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 28th, 2018
Last updated Jul 6th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669977997 NPPES
Colorado MEDICAID 9000163141

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