Healthcare Provider Details

I. General information

NPI: 1659340305
Provider Name (Legal Business Name): ROCKY MOUNTAIN OBGYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 EAST 9TH AVENUE BLDG II, STE 200
DENVER CO
80220-3921
US

IV. Provider business mailing address

4500 EAST 9TH AVENUE BLDG II, STE 200
DENVER CO
80220-3921
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-0055
  • Fax: 303-399-7764
Mailing address:
  • Phone: 303-399-0055
  • Fax: 303-399-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: BARBARA J NICHOLAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-399-0055