Healthcare Provider Details

I. General information

NPI: 1710910823
Provider Name (Legal Business Name): SOUTH DENVER NEPHROLOGY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E HARVARD AVE SUITE 240
DENVER CO
80210-7006
US

IV. Provider business mailing address

950 E HARVARD AVE SUITE 240
DENVER CO
80210-7006
US

V. Phone/Fax

Practice location:
  • Phone: 303-871-0977
  • Fax: 303-733-2387
Mailing address:
  • Phone: 303-871-0977
  • Fax: 303-733-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number23200
License Number StateCO

VIII. Authorized Official

Name: MARK A DILLINGHAM
Title or Position: PRESIDENT/PARTNER
Credential: M.D
Phone: 303-891-0977