Healthcare Provider Details

I. General information

NPI: 1407481740
Provider Name (Legal Business Name): COLORADO PAIN PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S COLORADO BLVD STE 700
DENVER CO
80222-3325
US

IV. Provider business mailing address

1355 S COLORADO BLVD STE 700
DENVER CO
80222-3325
US

V. Phone/Fax

Practice location:
  • Phone: 303-277-0700
  • Fax: 303-277-0714
Mailing address:
  • Phone: 303-277-0700
  • Fax: 303-277-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT Z MOGHIM
Title or Position: OWNER/PHYSICIAN
Credential:
Phone: 303-888-2219