Provider Demographics
NPI:1861196859
Name:THERIANOS, ALEXIOS DEMETRIOS (DO)
Entity type:Individual
Prefix:
First Name:ALEXIOS
Middle Name:DEMETRIOS
Last Name:THERIANOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18050 E EASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FOXFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1515
Mailing Address - Country:US
Mailing Address - Phone:719-464-7677
Mailing Address - Fax:
Practice Address - Street 1:18050 E EASTER AVE
Practice Address - Street 2:
Practice Address - City:FOXFIELD
Practice Address - State:CO
Practice Address - Zip Code:80016-1515
Practice Address - Country:US
Practice Address - Phone:719-464-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program