OrganizationActive
Pediatric Associates of Canon City, Prof. LLC
NPI 1457498131 · Pediatric Adolescent Medicine Physician · Canon City, CO
Provider details
- NPI number
- 1457498131
- Entity type
- Organization
- Primary specialty
- Pediatric Adolescent Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Roger Noland, General Manager(719) 269-1727
- License
- 23117 (CO)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1335 Phay Ave
Suite a
Canon City, CO 81212-2334
Phone: (719) 269-1727
Fax: (719) 269-1730
Approximate (ZIP-level) locationGet directions
Mailing address
1335 Phay Ave
Canon City, CO 81212-2334
Registry dates
- Enumerated
- 2007-01-31
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.