Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Pediatric Associates of Canon City, Prof LLC

Organization Pediatric Adolescent Medicine Physician · NPI 1457498131

Pediatric Associates of Canon City, Prof LLC is a Pediatric Adolescent Medicine Physician in Canon City, Colorado. Licensed in Colorado. Registered with an NPI since 2007.

Licensed in
CO
In the registry since
2007
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1335 Phay Ave Ste A
Canon City, CO 81212-2334
Phone: (719) 269-1727
Fax: (719) 269-1730
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Adolescent Medicine Physician (primary) Taxonomy 2080A0000X · Licence 23117 (CO)

Record details

NPI number1457498131
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Roger Noland — General Manager · (719) 269-1727
NPI enumeratedJanuary 31, 2007
Last updated in NPPESAugust 22, 2020
Mailing address1335 Phay Ave, Suite A, Canon City, CO 81212-2334

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