Provider Demographics
NPI:1548466915
Name:SECOND GLANCE PROF LLC
Entity type:Organization
Organization Name:SECOND GLANCE PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-781-2515
Mailing Address - Street 1:701 E HAMPDEN AVE
Mailing Address - Street 2:120
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2736
Mailing Address - Country:US
Mailing Address - Phone:303-781-2515
Mailing Address - Fax:303-781-5809
Practice Address - Street 1:701 E HAMPDEN AVE
Practice Address - Street 2:120
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2736
Practice Address - Country:US
Practice Address - Phone:303-781-2515
Practice Address - Fax:303-781-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty