Healthcare Provider Details

I. General information

NPI: 1811998289
Provider Name (Legal Business Name): MARK H NATHANSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S POTOMAC ST STE 370
AURORA CO
80012-5455
US

IV. Provider business mailing address

1550 S POTOMAC ST STE 370
AURORA CO
80012-5455
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-1080
  • Fax: 303-750-4913
Mailing address:
  • Phone: 303-369-1080
  • Fax: 303-750-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32517
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: