Healthcare Provider Details

I. General information

NPI: 1619993250
Provider Name (Legal Business Name): JOEL SHEBOWICH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 E BRIARWOOD AVE STE 215
CENTENNIAL CO
80112-3846
US

IV. Provider business mailing address

13111 E BRIARWOOD AVE STE 215
CENTENNIAL CO
80112-3846
US

V. Phone/Fax

Practice location:
  • Phone: 303-680-9150
  • Fax: 303-680-9149
Mailing address:
  • Phone: 303-680-9150
  • Fax: 303-680-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOEL SHEBOWICH
Title or Position: PHYSICIAN - OWNER
Credential: MD
Phone: 303-680-9150