Healthcare Provider Details

I. General information

NPI: 1972659571
Provider Name (Legal Business Name): ADAM D MANCHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4380 S SYRACUSE ST STE 120
DENVER CO
80237-3094
US

IV. Provider business mailing address

455 SHERMAN ST STE 510
DENVER CO
80203-4400
US

V. Phone/Fax

Practice location:
  • Phone: 303-422-9438
  • Fax:
Mailing address:
  • Phone: 303-377-6825
  • Fax: 303-780-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number45435
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: