Healthcare Provider Details

I. General information

NPI: 1043280407
Provider Name (Legal Business Name): BIJAN ROSHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE SUITE # 565
DENVER CO
80210-5073
US

IV. Provider business mailing address

850 E HARVARD AVE SUITE #565
DENVER CO
80210-5073
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-3333
  • Fax: 303-733-4441
Mailing address:
  • Phone: 303-777-3333
  • Fax: 303-733-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8789
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number155137
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38341
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number155137
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number8789
License Number StateMT
# 6
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number51352
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: