Healthcare Provider Details

I. General information

NPI: 1306895578
Provider Name (Legal Business Name): ROBERT CLARKE MAIOCCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 03/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 S PARKER RD SUITE 100
AURORA CO
80014-2914
US

IV. Provider business mailing address

3025 S PARKER RD SUITE 100
AURORA CO
80014-2914
US

V. Phone/Fax

Practice location:
  • Phone: 303-481-7030
  • Fax: 303-745-7665
Mailing address:
  • Phone: 720-981-9740
  • Fax: 720-981-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36651
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: