Anthony Richard Declusin, MD
Psychiatry & Neurology, Neurology in Longmont, CO. Individual provider (NPI-1).
NPI number1669977997
StatusActive
Last updated in NPPESJul 6, 2023
Details
- NPI
- 1669977997
- Entity type
- Individual (NPI-1)
- Name
- Anthony Richard Declusin
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 28, 2018
- Certification date
- Jul 6, 2023
- Last updated
- Jul 6, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology, Neurology | DR.0066615 | CO | Yes |
| 208D00000X | General Practice | DR.0066615 | CO |
Practice location
1925 Mountain View AveLongmont, CO 80501-3128
Phone 720-718-8070 · Fax 720-494-3107
Mailing address
1925 Mountain View AveLongmont, CO 80501-3128
Phone 720-718-8070 · Fax 720-494-3107
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