Healthcare Provider Details

I. General information

NPI: 1073561007
Provider Name (Legal Business Name): SEAN T AMSBAUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 S POTOMAC ST SUITE 124
AURORA CO
80012-6165
US

IV. Provider business mailing address

1390 S POTOMAC ST SUITE 124
AURORA CO
80012-6165
US

V. Phone/Fax

Practice location:
  • Phone: 303-368-8611
  • Fax: 303-368-9791
Mailing address:
  • Phone: 303-368-8611
  • Fax: 303-368-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number44388
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number44388
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: