Healthcare Provider Details

I. General information

NPI: 1912466962
Provider Name (Legal Business Name): DOUG JAMES COMISKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S FEDERAL BLVD
DENVER CO
80219-4837
US

IV. Provider business mailing address

1601 S FEDERAL BLVD
DENVER CO
80219-4837
US

V. Phone/Fax

Practice location:
  • Phone: 303-935-5652
  • Fax:
Mailing address:
  • Phone: 303-935-5652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: