Healthcare Provider Details

I. General information

NPI: 1497983456
Provider Name (Legal Business Name): MOLLY JANE GOLOBACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY JANE WEINER M.D.

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4949
  • Fax: 303-602-5184
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125056427
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR52113
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: