Healthcare Provider Details

I. General information

NPI: 1225909773
Provider Name (Legal Business Name): CERES PHYSICIANS COLORADO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 LAWRENCE ST
DENVER CO
80202-2946
US

IV. Provider business mailing address

1 DANIEL BURNHAM CT STE 110C
SAN FRANCISCO CA
94109-0456
US

V. Phone/Fax

Practice location:
  • Phone: 415-964-5618
  • Fax: 415-964-5619
Mailing address:
  • Phone: 415-964-5618
  • Fax: 415-964-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER CHARLES KLATSKY
Title or Position: PARTNER
Credential: MD
Phone: 415-964-5618