Healthcare Provider Details

I. General information

NPI: 1649563917
Provider Name (Legal Business Name): WILLIAM WENOKOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PENROSE PL SUITE 130
BOULDER CO
80301-1878
US

IV. Provider business mailing address

3445 PENROSE PL SUITE 130
BOULDER CO
80301-1878
US

V. Phone/Fax

Practice location:
  • Phone: 303-541-9557
  • Fax: 303-444-5551
Mailing address:
  • Phone: 303-541-9557
  • Fax: 303-444-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31479
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number31479
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: