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Contact Information

JAMES A DERRISAW, MD
1236 E ELIZABETH ST
SUITE 1
FORT COLLINS, CO80524-4000
 Phone: 970-224-2985
 Fax: 970-472-9381
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
 

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
Indicates primary specialty

NPI Profile & details for JAMES A DERRISAW · (Male)

NPI # 1710975586
Status Active
Credentials MD
Entity Individual
Enumeration date 10/06/2005
Last updated 06/06/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • CO License # 39525
  • CO License # DR.0039525
  • NE License # 26018
  • WY License # 6553A
  • CO Medicaid 04051262
  • WY Medicaid 119537900
Hospital affiliation(s)
  • IVINSON MEMORIAL HOSPITAL - (Acute Care)
    255 N 30TH
    LARAMIE, WY 82072
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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