Healthcare Provider Details

I. General information

NPI: 1790703239
Provider Name (Legal Business Name): MOUNTAIN RHEUMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E 9TH AVE NO 500 S
DENVER CO
80220-3900
US

IV. Provider business mailing address

4500 E 9TH AVE NO 500 S
DENVER CO
80220-3900
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-2190
  • Fax: 303-355-4435
Mailing address:
  • Phone: 303-861-2190
  • Fax: 303-355-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DAVID KORMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 303-861-2190