Healthcare Provider Details

I. General information

NPI: 1790759843
Provider Name (Legal Business Name): DR. OLIVER GYSIN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 VINE ST BRIARWOOD
DENVER CO
80206-2016
US

IV. Provider business mailing address

2185 BROADWAY
DENVER CO
80205-2534
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-0350
  • Fax: 303-333-4841
Mailing address:
  • Phone: 303-296-2244
  • Fax: 303-296-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1500
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: