Healthcare Provider Details

I. General information

NPI: 1235994104
Provider Name (Legal Business Name): RAREDISEASEDOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28013 E NOVA PL
AURORA CO
80016-7437
US

IV. Provider business mailing address

28013 E NOVA PL
AURORA CO
80016-7437
US

V. Phone/Fax

Practice location:
  • Phone: 301-379-2275
  • Fax: 720-580-5613
Mailing address:
  • Phone: 301-379-2275
  • Fax: 720-580-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA BULBIN DUIS
Title or Position: OWNER, MEDICAL DIRECTOR
Credential: MD
Phone: 301-379-2275