Healthcare Provider Details

I. General information

NPI: 1003099128
Provider Name (Legal Business Name): DR JAY DWORKIN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S POTOMAC ST STE 380
AURORA CO
80012-5458
US

IV. Provider business mailing address

1550 S POTOMAC ST STE 380
AURORA CO
80012-5458
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-1044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number280
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number280
License Number StateCO

VIII. Authorized Official

Name: DARLA A JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-369-1045