Healthcare Provider Details

I. General information

NPI: 1316189152
Provider Name (Legal Business Name): DENNIS M. WEISBROD M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
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: DENNIS MAURICE WEISBROD
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 303-931-9344