Healthcare Provider Details

I. General information

NPI: 1811910383
Provider Name (Legal Business Name): ROBERT HOLLOWAY BEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 IDYLWILD TRL STE 105
BOULDER CO
80301-3806
US

IV. Provider business mailing address

5412 IDYLWILD TRL STE 105
BOULDER CO
80301-3806
US

V. Phone/Fax

Practice location:
  • Phone: 303-938-9284
  • Fax: 720-652-0408
Mailing address:
  • Phone: 303-938-9284
  • Fax: 720-652-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30731
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: