Healthcare Provider Details

I. General information

NPI: 1194782250
Provider Name (Legal Business Name): DENNIS MAURICE WEISBROD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE SUITE 4200
DENVER CO
80218-1216
US

IV. Provider business mailing address

1601 E 19TH AVE SUITE 4200
DENVER CO
80218-1216
US

V. Phone/Fax

Practice location:
  • Phone: 303-831-8344
  • Fax: 303-861-8615
Mailing address:
  • Phone: 303-831-8344
  • Fax: 303-861-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number17058
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: