Healthcare Provider Details

I. General information

NPI: 1568466027
Provider Name (Legal Business Name): WILLIAM ROGER MARKEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W MIDWAY BLVD
BROOMFIELD CO
80020-2090
US

IV. Provider business mailing address

13624 ASPEN ST
BROOMFIELD CO
80020-9695
US

V. Phone/Fax

Practice location:
  • Phone: 303-466-1866
  • Fax:
Mailing address:
  • Phone: 303-466-3620
  • Fax: 303-466-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number13310
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: