1902984024 NPI number — MARSHALL R GOTTESFELD MD

Table of content: MARSHALL R GOTTESFELD MD (NPI 1902984024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902984024 NPI number — MARSHALL R GOTTESFELD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOTTESFELD
Provider First Name:
MARSHALL
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902984024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ELDORADO BLVD
Provider Second Line Business Mailing Address:
SUITE 6250
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80021-3408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-272-0751
Provider Business Mailing Address Fax Number:
303-318-2488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1960 OGDEN ST STE 340
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80218-3669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-318-3830
Provider Business Practice Location Address Fax Number:
303-318-3825
Provider Enumeration Date:
11/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  32176 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01021765 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".