Healthcare Provider Details

I. General information

NPI: 1083248603
Provider Name (Legal Business Name): ANNEST SYNN NOWAK & MUBARAK PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 COUNTY ROAD 14
DEL NORTE CO
81132-8758
US

IV. Provider business mailing address

1601 E 19TH AVE STE 3950
DENVER CO
80218-1256
US

V. Phone/Fax

Practice location:
  • Phone: 719-657-2510
  • Fax: 713-657-3317
Mailing address:
  • Phone: 303-539-0736
  • Fax: 303-539-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JEFFRIE SCOTT DRURY
Title or Position: CONTOLLER
Credential:
Phone: 303-539-0736