Healthcare Provider Details

I. General information

NPI: 1609812106
Provider Name (Legal Business Name): BARBARA JEAN DIVISH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 INTERNATIONAL CIR STE 140
COLORADO SPRINGS CO
80910-3127
US

IV. Provider business mailing address

3205 N ACADEMY BLVD SUITE 130
COLORADO SPRINGS CO
80917-5101
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax: 719-344-7817
Mailing address:
  • Phone: 719-632-5700
  • Fax: 719-344-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01048913A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0047535
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: