Healthcare Provider Details

I. General information

NPI: 1609816693
Provider Name (Legal Business Name): ROBERT UNDERHILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 E WOODMEN RD SUITE 105
COLORADO SPRINGS CO
80923-2607
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-8704
  • Fax: 719-597-6864
Mailing address:
  • Phone: 719-538-2900
  • Fax: 719-538-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34432
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: