1558370379 NPI number — MALCOLM S DOBROW MD

Table of content: MALCOLM S DOBROW MD (NPI 1558370379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558370379 NPI number — MALCOLM S DOBROW MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOBROW
Provider First Name:
MALCOLM
Provider Middle Name:
S
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:
1558370379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10700 E GEDDES AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-3861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-9190
Provider Business Mailing Address Fax Number:
720-874-4462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 S POTOMAC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-761-9190
Provider Business Practice Location Address Fax Number:
720-874-4462
Provider Enumeration Date:
08/08/2006

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: 2085R0202X , with the licence number:  20146 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 25157 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 04-36296 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD17543 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1558370379 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01201466 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200424880A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200425120A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205735801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209903806 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104686070 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558370379 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679513196 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179544 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84-059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99112263 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558370379 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558370379 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2736490 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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