Provider Demographics
NPI:1487767364
Name:LONE TREE FAMILY PRACTICE PROFESSIONAL LLC
Entity type:Organization
Organization Name:LONE TREE FAMILY PRACTICE PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:M
Authorized Official - Last Name:CEDARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-225-0025
Mailing Address - Street 1:10103 RIDGEGATE PKWY
Mailing Address - Street 2:SUITE G-23
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5520
Mailing Address - Country:US
Mailing Address - Phone:303-225-0025
Mailing Address - Fax:
Practice Address - Street 1:10103 RIDGEGATE PKWY
Practice Address - Street 2:SUITE G-23
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5520
Practice Address - Country:US
Practice Address - Phone:303-225-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC521888Medicare PIN