Provider Demographics
NPI: | 1225909773 |
---|---|
Name: | CERES PHYSICIANS COLORADO PC |
Entity type: | Organization |
Organization Name: | CERES PHYSICIANS COLORADO PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PARTNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PETER |
Authorized Official - Middle Name: | CHARLES |
Authorized Official - Last Name: | KLATSKY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 415-964-5618 |
Mailing Address - Street 1: | 1 DANIEL BURNHAM CT STE 110C |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN FRANCISCO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94109-0456 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-964-5618 |
Mailing Address - Fax: | 415-964-5619 |
Practice Address - Street 1: | 1900 LAWRENCE ST |
Practice Address - Street 2: | |
Practice Address - City: | DENVER |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80202-2946 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-964-5618 |
Practice Address - Fax: | 415-964-5619 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2025-09-17 |
Last Update Date: | 2025-09-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207VE0102X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology | Group - Single Specialty |