Gwynn Antonson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0050578 Issued in CO

Practice address

4020 Jerry Murphy Rd
Pueblo, CO 81001-1045

Phone

(719) 546-3600

Fax

(719) 546-0931

NPI assigned

May 19, 2008

Last updated

May 16, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557964800000",
    "number": "1700043692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 JERRY MURPHY RD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011045",
            "telephone_number": "719-546-3600",
            "fax_number": "719-546-0931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 JERRY MURPHY RD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011045",
            "telephone_number": "719-546-3600",
            "fax_number": "719-546-0931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONSON",
        "first_name": "GWYNN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-19",
        "last_updated": "2019-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "0050578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65425871",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.