Healthcare Provider Details

I. General information

NPI: 1134048309
Provider Name (Legal Business Name): GRAHAM GANSAR AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6870 W 52ND AVE STE 207
ARVADA CO
80002-3953
US

IV. Provider business mailing address

4084 CLEAR CREEK DR APT 307
GOLDEN CO
80401-2083
US

V. Phone/Fax

Practice location:
  • Phone: 720-740-1551
  • Fax:
Mailing address:
  • Phone: 303-704-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0001381
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: