Healthcare Provider Details

I. General information

NPI: 1184388936
Provider Name (Legal Business Name): ERIC MAYHEW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WHEELING ST
AURORA CO
80045-7211
US

IV. Provider business mailing address

19296 W 59TH DR
GOLDEN CO
80403-2151
US

V. Phone/Fax

Practice location:
  • Phone: 720-723-7010
  • Fax:
Mailing address:
  • Phone: 720-530-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN1667857
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: