Healthcare Provider Details

I. General information

NPI: 1174576037
Provider Name (Legal Business Name): RICHARD GAMUAC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 S YOSEMITE ST STE 402
CENTENNIAL CO
80112-1406
US

IV. Provider business mailing address

6801 S YOSEMITE ST STE 402
CENTENNIAL CO
80112-1406
US

V. Phone/Fax

Practice location:
  • Phone: 303-773-9000
  • Fax: 303-770-1449
Mailing address:
  • Phone: 303-773-9000
  • Fax: 303-770-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberDR.0037964
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0037964
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: