DR. GWYNN ANTONSON (NPI# 1700043692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700043692 |
| Entity Type | Individual |
| Full Name | DR. GWYNN ANTONSON |
| Credential | D.O. |
| Practice Address |
4020 Jerry Murphy Rd Pueblo CO 81001-1045 |
| Practice Telephone | 7195463600 |
| Practice Fax Number | 7195460931 |
| Mailing Telephone | 7195463600 |
| Mailing Fax Number | 7195460931 |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2019-05-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 0050578 | CO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 65425871 | 05 |
| Street Address |
4020 JERRY MURPHY RD |
| City | PUEBLO |
| State | CO |
| Zip Code | 81001-1045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295807543 | University Family Medicine Center, P.C. | Family Medicine | 4020 Jerry Murphy Rd, Pueblo, CO 81001-1045 | 2006-11-14 |
| 1760999692 | Marissa Lussier | Nurse Practitioner | 4020 Jerry Murphy Rd, Pueblo, CO 81001-1045 | 2017-12-30 |
| 1649530122 | Veronica Lynn Ritchey | Nurse Practitioner | 4020 Jerry Murphy Rd, Pueblo, CO 81001-1045 | 2012-05-18 |
| 1245395649 | Lawrence C Anaya | Family Medicine | 4020 Jerry Murphy Rd, Pueblo, CO 81001-1045 | 2006-12-26 |
| 1609931013 | Cheryl Brudos Wills | Family Medicine | 4020 Jerry Murphy Rd, Pueblo, CO 81001-1045 | 2006-12-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588222863 | 1111 Bonforte Opco LLC | Respite Care | 855 Hunter Dr., Pueblo, CO 81001 | 2019-06-03 |
| 1992276026 | Andrew Benjamin Basham | Counselor | 1003 Rupple St Pueblo Co 81001, 606, Pueblo, CO 81001 | 2018-12-16 |
| 1316456981 | Amy R Leibli | Nurse Practitioner | 1080 Chinook Lane, Pueblo, CO 81001 | 2017-09-26 |
| 1457781262 | Ron Concialdi | Dentist | 2037 Jerry Murphy Rd., Pueblo, CO 81001 | 2013-11-14 |
| 1609146950 | Natasha Liette Mondragon | Registered Nurse | 1302 E. 5th, Pueblo, CO 81001 | 2012-01-04 |
| 1023303575 | Malinda Lee Davis | Registered Nurse | 1302 E 5th, Pueblo, CO 81001 | 2011-06-13 |
| 1679876429 | Michael Edward Leyba | Substance Abuse Rehabilitation Facility | 4 Montebello Rd., Pueblo, CO 81001 | 2010-12-17 |
| 1609008796 | Laura Ann Mcmahon | Nurse Practitioner | 4020 Jerry Murphy Rd/, Pueblo, CO 81001 | 2009-08-21 |
| 1730380882 | Corrine Stella Tafoya | Counselor | 44 Calhoun Rd, Pueblo, CO 81001 | 2007-05-29 |
| 1518171008 | George Henry Beck | Dentist | 1700 N Salem Ave, Suite A, Pueblo, CO 81001 | 2007-05-10 |
| Find all providers in zip 81001 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356992606 | Kristie Lamotta | Family Medicine | 1600 N Grand Ave Ste 350, Pueblo, CO 81003-2729 | 2019-09-26 |
| 1558898569 | Alexandra R B King | Family Medicine | Southern Colorado Family Medicine, 902 Lakeview Avenue, Pueblo, CO 81004 | 2017-05-22 |
| 1134484660 | Aparna Seetharama | Family Medicine | 1600 N. Grand Ave, Ste 260, Pueblo, CO 81003-2729 | 2012-07-11 |
| 1710275037 | Catholic Health Initiatives Colorado | Family Medicine | 916 Indiana Ave., Suite 120, Pueblo, CO 81004 | 2011-07-20 |
| 1124336169 | Timothy J Cawlfield, Md, Pllc | Family Medicine | 41 Montebello Rd Ste 210, Pueblo, CO 81001-1379 | 2010-09-23 |
| 1639308828 | Emma Iovane Stout | Family Medicine | 115 E. Riverwalk, Suite 200, Pueblo, CO 81003-2246 | 2009-07-08 |
| 1750510145 | Wendy Alejandra Girard | Family Medicine | 1925 East Orman Avenue, Suite A109, Pueblo, CO 81004 | 2009-07-07 |
| 1881839694 | Bryan A Hynes | Family Medicine | 415 N Grand Ave, Pueblo, CO 81003-3111 | 2008-12-08 |
| 1093988917 | Louise Mcdade | Family Medicine | 8 Carlile Pl, Pueblo, CO 81004-1213 | 2008-04-11 |
| 1891914693 | Prairie Medical Clinic Pllc | Family Medicine | 1726 S Prairie Ave, Pueblo, CO 81005-2253 | 2007-04-24 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.