Healthcare Provider Details

I. General information

NPI: 1225100324
Provider Name (Legal Business Name): SUSAN ELIZABETH DAMON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN ELIZABETH TEITSMA MD

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 S HOLLY CIR STE 260
CENTENNIAL CO
80112-6248
US

IV. Provider business mailing address

6909 S HOLLY CIR STE 260
CENTENNIAL CO
80112-6248
US

V. Phone/Fax

Practice location:
  • Phone: 303-981-0097
  • Fax:
Mailing address:
  • Phone: 720-773-7373
  • Fax: 720-773-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35186
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35186
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: