Healthcare Provider Details

I. General information

NPI: 1134154313
Provider Name (Legal Business Name): ANTHONY E MADRID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S POTOMAC ST STE 104
AURORA CO
80012-4526
US

IV. Provider business mailing address

3333 S WADSWORTH BLVD UNIT D100
LAKEWOOD CO
80227-5117
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-5553
  • Fax: 303-671-2790
Mailing address:
  • Phone: 303-205-1090
  • Fax: 303-205-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number41706
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: